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'vuiro <br /> SAN: IOAQUIN <br /> —COUNTY Environmental Health Department <br /> Greeiness gro+ s here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: `1 Inspector: CONSTRUCTION <br /> Facility Address: W• � s�w�� <br /> Well Address: N'_A. Total Depth: <br /> WP# C�O Well#: Drilling Rig Type: <br /> Soil Boring#: ��y , ?—Q - 3 . " Min 2"Annular EHD Seal Verified: ❑ Yes No <br /> Drilling Company: '[zi_w5 <br /> Driller Onsite: ����, Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: Ad cam, Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 3No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ��P ABOVE-GROUND C.HRISW-SOX <br /> Holding Temperature: COWLEr10N COMPLErioN <br /> Method: GroundSuixs <br /> Screening Method: grrout <br /> Verified Chain of Custody: ❑ Yes []No ' <br /> fi. <br /> SPOILS = <br /> Contamination Noted: El Yes ❑No <br /> If yes,spoils storage Location: - <br /> sacdon <br /> Covered: Yes ❑No = �, <br /> If yes, material: �� <br /> _ <br /> GROUTING or DESTRUCTION Total Depth: yo" <br /> Depth to Water: \4 QSc� 8' Jt. <br /> Grout Material: IU�Ci�PF� c T�� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Z,ao 3 <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED \ Bags Sand/Gravel: <br /> []Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity U'Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest Bags 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 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 U 5 25 50 5 <br /> 15 0 6 30 60 6 <br /> 17.5 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 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />