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SANF;JOAQUI" <br /> —COUNTY— <br /> Environlme d Health Department <br /> , <br /> ,; Greotness grotrs here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z '7 Ins ector:e _K_ CONSTRUCTION <br /> Facility A dre s: <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: _ ib <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes []No <br /> Driller Onsite: 'L 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 COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING W- T <br /> ABOVE-GROUND C}1A1511 80X <br /> Holding Temperature: COWLETION c Pt>ztoN <br /> Method: Ground sur acv <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> rt. <br /> SPOILS <br /> vN J• O <br /> Contamination Noted: ❑ Yes []No = <br /> If yes,spoils storage Location: �� r <br /> an <br /> Covered: ❑Yes ❑No <br /> If yes, material: " _ <br /> g-vW pack <br /> GROUTING or DESTRUCTION Total Depth:_ - <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑WeII.Destruction Blank Feet Screen Feet <br /> ❑BSlot Size: <br /> oring Installation 26ring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout Zemie <br /> er Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Baas Rallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest riBags Bentonite/Cement Mix 3% MIX 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 10 2 10 20 2 <br /> 7..5 15 3 15 30 3 Bentonite per 94 Ib 2.82 4.7 <br /> -i , <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 /> �� D 4a�Sj �_1 10/16/2017 <br /> 1868 E. Hazelton Avenue � Stockton,Californi 95205 I T 209 468-3420 1 F 209 464-0138 I, www.sicehd.com <br />