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SANJOAQUIN Environmental Health Department <br /> COU N TY----- <br /> Greatness <br /> Y---- <br /> Greatness grows here. <br /> ` Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspectorj� +1 fig (chi CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# flCqD'(21Well#: Drilling Rig Type: <br /> Soil Boring#: Q,-1 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Sa i� �, �i �<z .,�,_nIn <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: )eel,) V OE,, <br /> Filter Pack From: To: <br /> Geologist: A94 A\G,r, Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes E]No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLETION CCMPLEnON <br /> Method: Ground Surf=* <br /> Screening Method: or«n <br /> Verified Chain of Custody: ❑ Yes ❑No �ft' <br /> ft. <br /> it. <br /> SPOILS a. <br /> — m <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: sionad <br /> sactlon <br /> Covered: ❑ Yes ❑No <br /> gravolpack <br /> If yes, material: A- <br /> f � _ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: e-Li6l <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation jgBoring 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 _7;Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags 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 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 <br /> 17.5 35 7 35 70 <br /> 20 40 8 40 80 8 <br /> ZS fi � – ZS gal 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 20c9 468-3420 1 F 209 464-0138 www.sicehd.com <br /> �N \ l �e� ')t t\ <br />