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U IV co <br /> SAN�J0A0UIN <br /> yJ —COUNTY– <br /> Environmental Health Department <br /> a <br /> cw0P' Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �I�2�Zy Inspector: v, CONSTRUCTION <br /> Facility Address: <br /> Well Address: 1�1 \ N1cC1v„ c:tiw i �[v �, Total Depth: ,V <br /> WP# EQ C d I t1;t Well#: Drilling Rig Type: C ` <br /> Soil Boring#:_"'j-0'1 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Ccne fg i <br /> 4. Cr L',y <br /> Screen Length From: To: <br /> Driller Onsite: AC it< <br /> Filter Pack From: To: <br /> Consultant: <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 AWVE-GROUND <br /> Holding Temperature: COWPLETION COMPMN <br /> tE <br /> Method: G=ndSurf"' + " <br /> Screening Method: oraLd <br /> Verified Chain of Custody: ❑ Yes ❑No -�---n' <br /> it. <br /> ft. <br /> SPOILS a <br /> Contamination Noted: ❑ Yes ❑No = r <br /> If yes,spoils storage Location: <br /> aloud <br /> aeon <br /> Covered: ❑ Yes El NoZ EE_ gra„lw <br /> pacK <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: A"'% k� <br /> Depth to Water: x• n' <br /> Grout Material: 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 ❑Boring 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 1�ITremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 9Bags Bentonite/Cement Mix S% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 (Z' 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />