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�C.,�� SAN-JOAQUIN <br /> Environmental Health Department <br /> COUNTY— <br /> °w�rFoa`i Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ��ZZ�= Inspector: CONSTRUCTION 7i <br /> Facility Address: <br /> Well Address: �(� n ( .'� rS � C:r t It., Total Depth: <br /> WP# m yk9 Well#: Drilling Rig Type: <br /> Soil Boring#: 2, - ' , <br /> Drilling Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> g Com an p y:��r^ �� Screen Length From: To: <br /> Driller Onsite: /VK Filter Pack From: To: <br /> Consultant: ,,(Awr tw,/S <br /> Geologist: Bentonite From: To: <br /> Grout From: 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 /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CO6FLET1ON coo i nXTICN <br /> Method: Ground surra. <br /> Screening Method: or«n <br /> Verified Chain of Custody: ❑ Yes El No �---tt' <br /> tt. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> a <br /> If yes, spoils storage Location: slatted _ - Z <br /> iNction _ <br /> Covered: ❑ Yes ❑No <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> tt. <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation (9Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity )SITremie ❑Other: Type of Method: <br /> Water Ce e t 471b Water Cement 94 lb <br /> `' allons gallons Bags <br /> Thickest Thinnest FBags Thickest Thinnest ttBags Bentonite/Cement Mix 3%Mix S% Mix <br /> 2.5 5 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 15 3 15 30 3 <br /> 10 20 420 40 4 <br /> 12.5 1 25 5 25 50 5 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 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />