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SAN JOAQUIN <br /> Environmental Health Department <br /> ` —._..COUNTY <br /> cyr Greatness grows here. <br /> 4 Monitoring Well/Soil Boring Inspection Report <br /> Date:— I Inspector- i0i,, 19. CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: -3 It / � <br /> WP# �Well#: Drilling Rig Type: 141C/ <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes 11 No <br /> Drilling Company: VV /�` rlq <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: rVV7 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 1:1 No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVEGROUND <br /> Holding Temperature: COMPLETION CCCMPLEnON <br /> Method: around Surf"' <br /> Screening Method: orocrt <br /> Verified Chain of Custody: ❑ Yes El No <br /> ft. <br /> ft. <br /> SPOILS k <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: abe <br /> a�cfon rY <br /> Covered: ❑ Yes El No <br /> gravel pack <br /> If yes, material: n <br /> GROUTING or DESTRUCTION Tota D pth: 50 1 <br /> Depth to Water: �J n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: a <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity b6Tremie ❑Other: Type of Method: <br /> Water ceme4 Ib Water Cement 941b <br /> allons Basgallons Bags <br /> Thickest Thinnest tlBags Thickest Thinnest tlBags 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 /> 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 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />