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SAN ,,JOAQUIN Environmental Health Department <br /> COUNTY* <br /> Greetriess grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Addre s: <br /> Well Address: Total Depth: <br /> WP# 1�310`�Q 'MA Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Q�tvN'1 N��.�MAN Filter Pack From: To: <br /> Geologist: up��ti Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes WNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> OA- C,' o N <br /> Domestic Well Onsite: ❑ Yes K\No casing <br /> If yes, location and distance: height <br /> SAMPLING AZOyE.GROUNp <br /> Holding Temperature: COWLEMON 1°N CCOWLE>:MN <br /> Method: Ground Stxf=o'+••""' <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes El No i -tt- <br /> tt. <br /> SPOILS — <br /> , <br /> Contamination Noted: ElYes El No a <br /> If yes,spoils storage Location: == <br /> don <br /> Covered: ❑ Yes ❑No ` — <br /> pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ZA - _ <br /> Depth to Water: , m n' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation?�Boring 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 INTremie ❑other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rail ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 B <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 />