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SAN JOAQUIi, Environmental Health Department <br /> COUNTY" <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> � q ) <br /> DatJ ��� C 019 Inspector: � v CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# Cn L Well#: X-,> Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: - t'( Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLET;ON c �ncN <br /> Method: (Gond Sumacs <br /> Screening Method: a�«n <br /> Verified Chain of Custody: ❑ Yes [I No —` n' <br /> ft. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes 0 N =" <br /> If yes, spoils storage Location: siotwd <br /> aKJon <br /> Covered: ❑ Yes 1:1 No <br /> If yes, material: <br /> GROUTING or DESTRUCTION To al Depth: f _ <br /> Depth to Water: ' n' <br /> Grout Material: N , . - <br /> Gallons of Grout Used: 4 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> [-]Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> F1 Boring Installation) oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> �j Filter Pack Type/Size: <br /> 12ravity ❑Tremie ❑Other: Type of Method: <br /> / water Cement 471b Water Cement 94 lb <br /> gallons Bas Rall ons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 3% 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 /> 10 20 4 20 40 4 <br /> 12.5 25 5. 25 50 5 <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 />