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SAN JOAQUIN <br /> Environmental Health Department <br /> —COUNTY -- <br /> °a� P Greatness grows here. <br /> / Monitoring Well/Soil Boring Inspection Report <br /> Date O� Inspector: DL-�z0" - CONSTRUCTION <br /> Facility Address: 00 <br /> Well Addre Total Depth: <br /> WP# Well#: Drilling Rig Type: J.1� <br /> Soil Boring#: <br /> DrillingCompany: Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: p Filter Pack From: To: <br /> Geologist: <br /> 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: lff�_T height <br /> SAMPLING ABOVE-GROUND _ _ <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: Ground Surface <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> n. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No ` <br /> If yes,spoils storage Location: II slotted <br /> Covered: ❑ Yes ❑No <br /> If yes, material: 56 N <br /> zz I <br /> GROUTING or DESTRUCTION Total Depth: 3' J' • =_ <br /> Depth to Water: 10 <br /> Grout Material: ��T <br /> Gallons of Grout Used: 2a0 4c,� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> E]Boring Installation I? <br /> 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 /> El Gravity <br /> --ch ❑Other: Type of Method: <br /> Water Cemen 471 Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest uBags Bentonite/Cement Mix 3% Mix /a Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 <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 1 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> 6. �-k IZ9 b„/ 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />