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Ppuip c,R <br /> v SAN:J O A Q U I N Environmental Health Department <br /> i <br /> COUNTY <br /> Qgrr� Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: d1 ZU 21 Inspector: 1 i n S CONSTRUCTION <br /> Facility Address: <br /> Well Address: 10 Total Depth: <br /> WP# WA\ u,9' Well#: Drilling Rig Type: <br /> Soil Boring#: 9. Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: \Lm Qin Assxio_4es J I'LL Screen Length From: To: <br /> Driller Onsite: <br /> �w Filter Pack From: To: <br /> Consultant: 1Ltz�ZIP�'� 4; /�550(.i 0. t?5 .J./1L <br /> Geologist: w 6p_ 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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING A WVE-GROUND <br /> Holding Temperature: iOtrPLETtON coti+P=CN <br /> Method: G=nd Surtarn <br /> Screening Method: ar«A <br /> Verified Chain of Custody: ❑ Yes El No �tt' <br /> tt. <br /> tt. <br /> SPOILS <br /> Y. <br /> 0 <br /> Contamination Noted: ❑ Yes EJ No <br /> C <br /> If yes, spoils storage Location: <br /> slatted <br /> sac.on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> tt <br /> GROUTING or DESTRUCTION Total Depth: =_ <br /> Depth to Water: " tt' <br /> Grout Material: W' <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring InstallationJBoring 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 KTremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 941b <br /> allons Bags Rallons Bags <br /> Thickest Thinnest 'V 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 25 5 25 so 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 8o 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 />