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I <br /> SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> GrE6t i.- j; <br /> Q Monitoring Well/Soil Boring Inspection Report <br /> Date:V Inspector: CONSTRUCTION <br /> Facility Address: ()Iq )C-7 Q r b Nd� <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: r1a�(jY►'V <br /> Driller Onsite: ( (j Screen Length From: To: <br /> Consultant: LC,1'1'G�(,fP�/ Filter Pack From: To: <br /> Geologist: ��/j 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: T I height <br /> SAMPLING ABOVE-GROUND _ <br /> Holding Temperature: COWLEMN cOMPLETIoN <br /> Method: G=nd S"iac' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —` —tt' <br /> tt. <br /> tt. <br /> SPOILS = <br /> = a <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: .tonal <br /> aac9cn <br /> Covered: ❑ Yes ❑No = r <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: "— 1 tt 71 <br /> - tt' <br /> Grout Material:�0(l MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring InstallationBoring Destruction <br /> Bags of 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 /> gallons Bas callons Bags <br /> Thickest Thinnest .Bags Thickest Thinnest 9Bags 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 15 30 3 <br /> 10 20 c2i 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 3060 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 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 wvvw.sicehd.com <br />