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SAN. J OAO U I k Environmental Health Department <br /> COUNTY- <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: {1 Ia l In pecto : C riV/`� CONSTRUCTION <br /> Facility Address: rn dor- / <br /> Well Address: 'F `Total Depth: l� <br /> WP# S Well#: Drilling Rig Type: A <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: '57 3 <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 casting <br /> If yes, location and distance: height: <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLETION COMP�iEnON <br /> Method: Ground$urf°a' <br /> Screening Method: oroi1 <br /> Verified Chain of Custody: ❑ Yes E]No �ft' <br /> ft. <br /> it. <br /> SPOILS Y <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: stoned <br /> sac�on <br /> Covered: ❑ Yes []No = Y++t <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: `7 ' <br /> Depth to Water: tt. <br /> Grout Material: <br /> Gallons of Grout Used: P\4 (0(> MATERIALS/DEVELOPMENT �� <br /> Casing Type: _ <br /> ')Well Installation ❑Well Destruction Blank _Feet ScreenFeet <br /> Slot Size: o. 01 <br /> ❑Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: Z <br /> Type/Brand of Bentonite: P <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity remie ❑Other: Type of Method: 1�iP;lnn <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 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 4 20 40 4 <br /> 12.5 25 5 25 so 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 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 />