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SAN.-.,JOAQUIN Environmental Health Department <br /> .C.O U N TY— <br /> Greatness groins here_ <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date^ `�. W"" Inspector: CONSTRUCTION <br /> Facility Addre s: � (i1CfF <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: �,p� <br /> Driller Onsite: <br /> Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: WYes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yeslo casing <br /> If yes, location and distance: height <br /> e <br /> SAMPLING N�� <br /> ABaS-61RcuNn ,c�:sr;'-sox <br /> Holding Temperature: � �'� CA:)W EnON <br /> Method: a`°"r'�$` + <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑ Yes ❑No fL <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No r' a <br /> If yes, spoils storage Location: arae y E <br /> sac3on <br /> Covered: ❑ Yes ❑No <br /> 12— <br /> If yes, material: ` ll <br /> GROUTING or DESTRUCTION Total Depth: �r <br /> Depth to Water: fL ' <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 /> El Boring Installationl3voring 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 �(Tremie ❑Other: Type of Method: <br /> Water I Cement 471b Water Cement 941b <br /> Ilons Baas Rall ons Bags <br /> Thickest Thinnest 4Bags 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 io 1 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 '3 15 30 3 —i <br /> l0 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 1 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />