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p"._, F CO <br /> s SANJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> (� Monitoring Well/Soil Boring Inspection Report <br /> Date: -I Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP#00`'I Well#:__O Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2" Annular EHD Seal Verified: ❑ Yes []No <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 El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING A80VE-GROUND <br /> Holding Temperature: COtFLnoN C*Mpt EON <br /> Method: G=ndSurtace + <br /> Screening Method: grmn <br /> Verified Chain of Custody: ❑ Yes ❑No -r—ft. <br /> tt. <br /> ft. <br /> SPOILS ; <br /> Contamination Noted: ❑ Yes El No = <br /> If yes, spoils storage Location: slotted <br /> sacton <br /> Covered: ❑ Yes ❑No = vns+Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total De the t� <br /> Depth to Water: ^' n• tt. <br /> Grout Material: <br /> q MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ^-3 o 0 p 1 <br /> Casing Type: <br /> ❑Well Installation _? AJell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> 11 <br /> ❑Pressure Grout OverDrill Filter Pack Type/Size: <br /> her: Type of Method: <br /> ❑ Gravity 6Tremie J <br /> Water Cement 71b Water Cement 94lb <br /> gall Bags gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 / D (� <br /> 1. 20 4 20 40 4 �/��\ 2 �, /r o N� S C2S , C.. Lis " ) <br /> I <br /> 12.5 25 5 25 50 5 p� J1 (�`� ,—,J, f <br /> 15 30 6 30 60 6 / 11 _ now J � ,1,�/ <br /> 17.5 35 7 35 70 7 f�S �i (JC.�/ CCCiiiirVVrr' <br /> 20 40 8 40 80 8 1p�,"r <br /> S � � � � � �� hOA00/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464=0138 1 www.sicehd.com <br />