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SAN.,>J OAQ U!N <br /> Environme.- ] Health Department <br /> —COUNTY— <br /> :;: Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspect r: CONSTRUCTION <br /> Facilityddr s: Q <br /> Well A dress: Total Depth: <br /> WPIC>iZ oo 7 ?4 3 6 Well#: Drilling Rig Type: <br /> Soil Boring# WTD <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite:� .- - Screen Length From: To: <br /> Consultant: y /, Filter Pack From: To: <br /> Geologist: b�� � �,,`� 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 <br /> Holding Temperature: coMPLErION CH8JSW-80X <br /> COMPLETION <br /> Method: Grand surra, <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No n <br /> fi. <br /> SPOILS — <br /> 'tiN J: O <br /> Contamination Noted: ❑ Yes ❑No -" <br /> _ <br /> If yes,spoils storage Location: 910 <br /> on <br /> Covered: ❑ Yes ❑No s I <br /> If yes, material: _ > <br /> GROUTING or DESTRUCTION Total Depth: 6P <br /> Depth to Water: G �, ft. _ M. <br /> Grout Material: - <br /> Gallons of Grout Used: ,� tirj � MATERIALS/DEVELOPMENT <br /> 1 ` Casing Type: <br /> ❑Well Installation ❑Well.Destruction 2t Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Deoring Destruction gags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravityremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> gallons Bags gallons Bags <br /> Thickest Thinnest #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 Nq Bentonite per 94 Ib 2.82 4.7 <br /> 7,5 15 3 15 30 <br /> 10 20 4 20 40 <br /> 12.5 25 5 25 50 15 30 6 30 60 17.5 35 7 35 70 20 44,0! 8 40 80 <br /> bio e/ 7 bN55 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 ( T 209 468-34201 F 209 464-0138 I, www.sicehd.com <br />