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auiy� <br /> SAN:IOAQUIN <br /> Environmental Health Department <br /> -COUNTY— <br /> Greatness grows here. <br /> 2 Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 Z3 Inspector: CONSTRUCTION <br /> Facility Add ess: - A=0;)b <br /> i-, <br /> Well Address: _ q Total Depth: <br /> WP# DoLkkWeIIN: I Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes El No <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 El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVEGROUND <br /> Holding Temperature: COLPLETION CC#AP�EnC)N <br /> Method: Ground Surf"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No eft. <br /> tt. <br /> -ft. <br /> SPOILS01. <br /> : _ <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: s►oUd <br /> on — B <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ( -S' <br /> Depth to Water: no —n• <br /> Grout Material: Ylle_� C mk^"k <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: CaGA Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation KBoring Destruction Bags Size: <br /> 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 /> allons Bas gallons Bags <br /> Thickest Thinnest RBags Thickest Thinnest tlBags 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 1515 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 1 www.sicehd.com <br />