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SAN JOAQUIN Environmental Health Department <br /> L. ---COUNTY--- <br /> ,.. vreatr,�ss yrorvs hc:,:, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �� I Insp ctor: /L Cl CONSTRUCTION <br /> Facility Address: yLee f <br /> Well Address: Total Depth:_ /� '/ f <br /> WP# G' %7 '> Well#: Drilling Rig Type: I -�`XIIA <br /> Soil Boring#: —7 — <br /> Drilling Company: —21z•: 'cat y� Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: C(� Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: � s 0 Bentonite <br /> V—( 5 From: To: <br /> Grout From: To: <br /> Public Water System Onsite: 11 Yes ❑No COMPLETION El Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING AZOVE-G ROUND <br /> Holding Temperature: COtVLET1ON OX <br /> conn�oN <br /> Method: Ground strtac+ <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: sbiwd <br /> a*c:cn <br /> Ccvered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: C11 <br /> :4. __ <br /> Depth to Water: N tL tt <br /> Grout Material: Lam ' i: .f MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation oring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> -Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bagsallons Bags <br /> Thickest Thinnest PBags Thickest Thinnest 9Bags Bentonite/Cement Mix 30/6 MIX 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 2 10 20 2 Bentonite per 94 Ib 1 2.821 4.7 <br /> 7.5 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />