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SAN.PJOAQUIN Environmental Health Department <br /> COU NTY---- <br /> 41 � Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> 2� �"/ <br /> Date: 1012M <br /> Inspector: S-k"r-ee CONSTRUCTION f r( S <br /> Facility Address: 20 Q �.��✓� to <br /> Well Address: Total Depth: <br /> WP# 0040Well#: Drilling Rig Type: <br /> Soil Boring#: I I " r?? Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller Onsite: U� s <br /> Consultant: ?,(,W�-� Filter Pack From: To: <br /> Geologist: him 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 /> _1WT <br /> SAMPLING ABOVE-GROUND <br /> COlv�LETION Gt1R15TY-80X <br /> Holding Temperature: C &*N_EnoN <br /> Method: <br /> Ground Surface <br /> Screening Method: pro"t <br /> Verified Chain of Custody: ❑ Yes ❑No �tt <br /> tt. <br /> tt. <br /> SPOILS = a <br /> Contamination Noted: ❑ Yes El No = <br /> C <br /> If yes, spoils storage Location: <br /> aeon <br /> Covered: ❑ Yes ❑No = gra„ I__k <br /> If yes, material: <br /> r .. <br /> I <br /> GROUTING or DESTRUCTION Total Depth: (D� <br /> Depth to Water: <br /> Grout Material: 1'e til' .yu MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring InstallationLf"Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity '�Tremie ❑Other: Type of Method: <br /> Water Ce ent 471b Water Cement 94lb <br /> gall s Bas gallons Bags <br /> Thickest Thinnest ttBags 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 /> 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 35 70 7 <br /> 20 40 40 80 8 <br /> 10/16/2017 <br /> 3 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />