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•pU1N� <br /> SAN JOQQUin Environmental Health Department <br /> a <br /> —COUNTY <br /> �`S94y ? Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: In gator: J! CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: ✓ �'� �t <br /> WP# l Well#: � Drilling Rig Type: H 5A L� ' <br /> Soil Boring#: <br /> Min 2" Annular EHD Seal Verjf�ied: El Yes ❑No <br /> Drilling Company: o �, 5 5.� <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: F, <br /> Filter Pack From: : .3 To: <br /> ��;,�;„�,� <br /> Bentonite From:�Y� To: <br /> Geologist: _ <br /> Grout From: 0 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: height <br /> SAMPLINGwaovz=-caour�o QVT <br /> Holding Temperature: COWLEMN pC-HPIZaox <br /> Method: Gmund Surl"' <br /> Screening Method: Rt arI«n <br /> Verified Chain of Custody: ❑ Yes ❑No L�ft. <br /> fl. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes 11 No <br /> If yes, spoils storage Location: stonad <br /> sacdon '— <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Dpth: <br /> Depth to Water: ►��S�i n n' <br /> Grout Material: a2A <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: P.�C— j V <br /> Casing Ty e: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: hj ec " vw <br /> METHOD USED Bags Sand/Gravel: s <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill (5�{'( U f' y�D <br /> Filter Pack Type/Size: 40 ; 1 <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall s Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest uBags 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 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 />