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SANJOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> �re:tness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �2 Inspector: CONSTRUCTION <br /> Facility Address: 19V 1oe' 1iG <br /> Well Address: \ Total Depth: <br /> WP# Well#: ��i �j� J Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal VeYified: ❑Yes ❑No <br /> Drilling Company: <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 No W <br /> Y COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes $0 casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLS MN EnoN <br /> Method: Gmdr-,d Su•taca <br /> Screening Method: J;rout <br /> Verified Chain of Custody: ❑ Yes El No Ott' <br /> fl. <br /> -ft. <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes El No x K . <br /> If yes,spoils storage Location: sbn2d <br /> sac5an <br /> Covered: ❑ Yes ❑No <br /> If yes, material: ► , <br /> GROUTING or DESTRUCTION Tptal Depth: <br /> Depth to Water: J n <br /> Grout Material: <br /> �Gallons of Grout Used: �b MATERIALS/DEVELOPMENT' Casing Type: <br /> L _well Installation []Well Destruction 'NCS-- Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest i7 Bags BentoniteXement MIX 3% Mix 5% MIX <br /> 2s 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 1 6 30 60 6 <br /> 17.5 35 1 7 35 70 7 <br /> 20 40 1 8 40 80 8 <br /> �$ 1 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209468-34201 F 209464-0138 1 www.sicehd.com <br />