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SAN 1OAQUIN Environmental Heafi h Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: ► ` CONSTRUCTION <br /> Facility Address: QD <br /> Well Address: Total Depth: <br /> WP# ab l ob(03 Well#: - �4 Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes WNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes �No <br /> cv�ina <br /> If yes, location and distance: Ir heal ht <br /> SAMPLING "11T <br /> �. <br /> ABOVE-GROUND Cri i;s Y 8UX <br /> Holding Temperature: CC&VL T!ON cct+FL -ricN <br /> Method: G=nd Sutacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ii. <br /> SPOILS Y <br /> Contamination Noted: ❑ Yes ❑No r` <br /> If yes,spoils storage Location: �� - <br /> aon _ <br /> Covered: ❑ Yes ❑No _ = PaCk <br /> If yes, material: — <br /> GROUTING or DESTRUCTION Total Depth: <br /> ti. <br /> Depth to Water: N QS n. — <br /> Grout Material: (Vt4,AT- (, `FtJ'C <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> EJBoring Installation NBoring Destruction <br /> 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 tkTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> ailons Bas eall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest riBags 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 4.71- <br /> 7.5 3 15 30 3 <br /> 10 20 20 40 4 <br /> 12.5 2 5 25 50 5 <br /> _. 15 3 6 30 60 6 <br /> 17.5 5 7 35 70 7 <br /> 20 40 B 40 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 />