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SAN JQAQUIN Environmental Health Department <br /> —COU NTY— <br /> Greatness grows here. <br /> Monitoring /ell/Soil Boring inspection Report <br /> Date: \f u\ Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# WQ Well#:_ Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: 1. � 'Q6^'�,�;��lr� Min 2"Annular EHD Seal Verified: 11 Yes El No <br /> Driller Onsite: �,tJ �i�, Screen Length From: To: <br /> �y�iC1�►F+</V9�G� Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: 4-71 Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes JI No casing <br /> If yes, location and distance: neight <br /> SAMPLING AanVE-GRCXJND <br /> Holding Temperature: a� '�`T t' c�OWLET o a <br /> Method: G=nxdSWaoa T "• <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No n- <br /> tt. <br /> ft. <br /> SPOILS — <br /> 0 <br /> Contamination Noted: ❑ Yes El No r -_ <br /> If yes, spoils storage Location: slotua _ <br /> sac3on _ <br /> Covered: ❑ Yes ❑No Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:��_ . =_ <br /> Depth to Water: n- <br /> Grout Material: �V T_ 1.A�� <br /> Gallons of Grout Used; MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation oring 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 dTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas Raill ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Gement Mix 3% MIX 5%MIX <br /> --r27§5 5 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 1 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 so 8 <br /> SS�sd. �ktu 10/16/2017 <br /> �t -s W* of eov t <br /> 1868 E. Hazelton Avenue Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />