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=° c°z SANsJOAQUIN <br /> Environmei..al Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: o Inspector: �01C�- CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# DOR I It well#: RV-121 Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: [I Yes ❑No <br /> Drilling Company: G�) Uit-kII-) Lnc_ <br /> Driller Onsite: coi� i 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 1:1 No casing <br /> If yes, location and distance: height <br /> I _WW_F <br /> SAMPLING N IR AWVE-GROUND <br /> Holding Temperature: COWFLET3ON COMPLETION <br /> Method: G=ndSurfxs + <br /> Screening Method: 01 groLA <br /> Verified Chain of Custody: ❑ Yes 1KNo -�---n' <br /> n. <br /> SPOILS <br /> ;.i <br /> Contamination Noted: L� Yes SNo <br /> If yes, spoils storage Location: 0 V\ C-,� Ii)hQhl� t�c� sbnad _ - <br /> m1�,' 15 `' r, I n -M� I on = B <br /> Covered: '''_11 ' ) Yes LJNo x•1,,5 dor = g, *I If yes, material: �^P.t'fAA. 2'1 +t',51"IV� <br /> GROUTING or DESTRUCTION Total Depth: Jv <br /> Depth to Water: r <br /> Grout Material: <br /> Gallons of Grout Used: "� d -C oMATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Well Destruction Irlq� Blank Feet Screen Feet <br /> �_J Slot Size: <br /> El Boring Installation ABoring Destruction �`� Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity KTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest ttBags 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 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 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />