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SANJOAQUIh <br /> Environmental Health Department <br /> Q <br /> F>=' COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Zo(y Inspector: CONSTRUCTION <br /> Facility Address: �?'/ 5—U <br /> Well Addro . �� Total Depth:� <br /> WP# © Well#: Drilling Rig Type: �lGvtd- /'I�t 'S17 <br /> Soil Boring#: i1� Min 2"Annular EHD Seal Verified: El Yes El 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 El No COMPLETION ❑Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes,location and distance: nssgnt <br /> SAMPLING ABOVE-6ROUNU crtats�veox <br /> Holding Temperature: COMPLEnoN COMPLETION <br /> Method: emun°sScreening Method:Method: grout <br /> Verified Chain of Custody: ❑Yes ❑NoB• <br /> H. <br /> SPOILS ft• <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: do <br /> nad <br /> seCJon _ <br /> Covered: El Yes []No <br /> gmw pack <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION To I Depth: <br /> Depth to Water: /V RMC h• — tt <br /> c, <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation []Well Destruction Blank Feet Screen Feet <br /> El Boring Installationoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water cement Ito Water Cement9416 <br /> allons Ba s N eallons Bags <br /> 'rh Thinnest a Thickest Thinnest #Bags _ BentonitelCement Mix 3%Mix 5% Mix_ <br /> 2. s 1 Z 5 10 1 Bentonile per47lb 1.41 2.47 <br /> s 10 10 20 2 Bentonile per g4lb 2.82 4.7 <br /> 7.5 35 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 1 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 3s 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />