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SAN.JOAQUIN <br /> Environmental Health Department <br /> —COU NTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: 4� CONSTRUCTION <br /> Facility Address: SJL <br /> Well Address: Total Depth: <br /> WP# \A\_koull Well#: 9 INN Drilling Rig Type: <br /> Soil Boring#: '$- L 3➢, �Z1 i �l Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: v.NY.tJo�N <br /> Screen Length From: To: <br /> Lc5 Filter Pack From: To: <br /> Consultant: <br /> Geologist:fin . Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: lyes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes N�No casing <br /> If yes, location and distance: height <br /> SAMPLING Nj P ABOVE-GROUND <br /> Holding Temperature: COMPLETION COwLETic� <br /> Method: G=ndSumacs <br /> Screening Method: ot«n <br /> Verified Chain of Custody: ❑ Yes E]No ft' <br /> ft. <br /> ft. <br /> SPOILSv �W <br /> Contamination Noted: ❑ Yes ENO <br /> If yes, spoils storage Location: slon&d <br /> sac9on -- S <br /> Covered: ❑ Yes ❑No = „a <br /> Pack <br /> If yes, material: C� <br /> GROUTING or DESTRUCTION Total Depth:•5 <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation E), Slot Size: <br /> $oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> to,Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> gallons Bas gallons Bags <br /> Thickest Thinnest riBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 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 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 Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />