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UIH <br /> SANJOAQUIN Environmental Health Department <br /> l —COUNTY— <br /> �c4<,Row?�\T'J Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: 4L4�f&"" CONSTRUCTION <br /> Facility Address: LS�Q-) 5R <br /> Well Address: Total Depth: <br /> W P# (X)?,7Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: 14 e <br /> Consultant:����w \[�,P( ; =�'1C- Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 000 COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ,1No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: OONFLETION COMPLEMN <br /> Method: Ground Sumacs <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> tt. <br /> tt. <br /> SPOILS w __ <br /> 1AK O <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: stoned <br /> ascdon <br /> Covered: ❑ Yes ❑No _ g-vw pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: fU, <br /> Depth to Water: I _% <br /> Grout Material: h6ti tCerO Psi MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation Woring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Wressure 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 gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 9Bags 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 1 30 6 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 184E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />