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I5- <br /> SANJOAQUIN <br /> Environmental Health Department <br /> •w <br /> COUNTY— <br /> \ <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �I9I�?� Inspector: CONSTRUCTION <br /> Facility Address: bb'I W. LQthrgD Q. Gb33(o <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From:-- To: <br /> Geologist: 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 /> ff- <br /> SAMPLING A15OVE-GROUND <br /> Holding Temperature: COMPLETION COM. <br /> OO .PLE .oN <br /> Method: GroundS"rfa" <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No - ---n- <br /> it. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No V <br /> If yes,spoils storage Location: <br /> afottod _ � <br /> ssc9 %�.on 7€ T <br /> Covered: ❑ Yes ❑No9-VW pack <br /> = <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:)- <br /> Depth to Water: M " — n- <br /> Grout Material: �E:rstcYte Pcti�rs <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation VWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags 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 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> i y�( ( I;t-t T ►� �\ Q�c cp 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 F 209 464-0138 1 www.sicehd.com <br />