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SANsJOAQUIN ' Environmen__9 Health Department <br /> COUNTY -- <br /> °v� P/ Greatness grows here. <br /> C Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: �� CONSTRUCTION <br /> Facility Address: 1 X21 <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> �?, Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller Onsite: r� Filter Pack From: To: <br /> Consultant: Gz0!50 � <br /> Geologist: ( 29.r,.��— m- e.,,i(�r Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLETION COMEnoN <br /> PP <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —` tt' <br /> ft. <br /> tt. <br /> SPOILS <br /> e <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted <br /> Covered: ElYes ❑Noan <br /> pnwl pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: g <br /> Depth to Water: — tt• <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> ZInstallation <br /> of Grout Used: <br /> Casing Type: <br /> ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <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 /> ❑ Gravity N+ ;femie []Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 1s 3 15 30 3 <br /> 10 20 4 20 40 4 AA C �lcL1 <br /> 12.5 25 5 25 50 5is 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 -#'�`(� �� l3�`- ✓�"�1 �'� � �' '�� <br /> 20 40 a 40 ao e <br /> 10/16/2017 <br /> 1.•✓:�c s...,'ti r <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 I P 209 464-0138 1 www.sicehd.com <br />