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SAN:JOAQUIN Environmental Health Department <br /> —COUNTY-- <br /> GrFatnes5 groris here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 0\ Inspector: CONSTRUCTION <br /> Facility Address: k <br /> Well Address: Total Depth: <br /> WP# �)1 \k%MWell#: Drilling Rig Type: <br /> Soil Boring#: - 3 <br /> Drillin Company: �� � �L, Min 2"Annular EHD Seal Verified: 11 Yes El No <br /> g p y: W � .� — <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: ���� Bentonite From: To: <br /> `�� � <br /> r\c-S Grout From: To: <br /> Public Water System Onsite: 1 Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING AZCV=--GROUND <br /> Holding Temperature: a�` 0CWLEsior�t <br /> Method: G=nd SWa" <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No 8. <br /> �t. <br /> ft. <br /> SPOILS <br /> T . <br /> Contamination Noted: ❑ Yes El No r' <br /> If yes,spoils storage Location: <br /> stcdon <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUC I N Total Depth: _=_ <br /> Depth to Water: _ <br /> Mn- <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation VBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 1 20 4 20 40 4 <br /> . <br /> 25 5 25 50 5 <br /> is <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />