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SARIJOAQUIN Environmental Health Department <br /> —COUNTY <br /> Greotness grows here. <br /> q Monitoring Well/Soil Boring Inspection Report <br /> Date:2 / Inspector: Ll nka CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# I m Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: rj&(A_ <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: mwTom Filter Pack From: To: <br /> Geologist: w. Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes []No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GRC JND <br /> Holding Temperature: CO&FLETION CHRIMx. <br /> COMPLETION <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> ts. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No a` <br /> If yes,spoils storage Location: =~ = C <br /> Slotted <br /> Covered: ❑ Yes ❑No — <br /> = gnwi pads <br /> If yes, material: <br /> Q 2 N-- <br /> GROUTING or DESTRUCTION Total Depth: z b Uri . '��. <br /> Depth to Water: n• " — n• <br /> Grout Material: C-M @A( MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction -f Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation/Noring Destruction Q(�� Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> 2S Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity 'Premie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas Pallons Bags <br /> Thier-st Thinnest J:B:..i Thi:.est Thinnest 9Bags [Bentonite <br /> ntonite/Ce_rnent Mix 3% Mix 5% Mix <br /> 10 1 ntonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 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 1 7 35 70 7 <br /> 20 40 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 www.sicehd.com <br />