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SAN JOAQUIN - a <br /> {. EnvironmenLdl Health Department <br /> �;9r� '`. / —COUNTY— <br /> + <br /> 9trFoc "� Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: i �L-) Inspector: CONSTRUCTION <br /> - <br /> Facility Address; i70 <br /> Well AddreW. Total Depth: b I ✓ <br /> WP# /7 II#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verif' ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite: ;L Screen Length From: To: <br /> Consultant: Filter Pack From: To:— <br /> Geologist: c I - Bentonite From: To: <br /> Grout From: To: <br /> .t <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 /> T �l <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION (ACHRt1WMTY405OX <br /> Method: Ground Sudacs <br /> Screening Method: o•�— <br /> Verified Chain of Custody: El Yes ❑No n' <br /> tt. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No " <br /> If yes, spoils storage Location: slotted '' <br /> asc�on = 3 <br /> Covered: ❑ Yes ❑No = G-vWpack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: a'V?{� i� fL In' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ell Installation ❑Well Destruction B� Feet Scre n Feet <br /> Slot Size: V <br /> El Boring Installation El Boring Destruction Bags of Cement: r t <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite.:❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas 9allons Bags <br /> Thicke!L,7,jhlnnest s Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 s 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 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />