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SAN.JOAQUIN Environmental Health Department <br /> --COU NTY-- <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 Inspector: cti1t CONSTRUCTION <br /> Facility A dress: 6 Gly " <br /> Well Addres : Total Depth: <br /> WP# �� �� Well#: Drilling Rig Type: <br /> Soil Boring#: - $ 9 j Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: k <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 /> iii <br /> SAMPLING �! ABOVE-GROUND <br /> Holding Temperature: j CO�"F�ION CCCMPLEnoN <br /> Method: Ground Surface <br /> Screening Method: groLt <br /> Verified Chain of Custody: ❑ Yes E]No -�--n' <br /> ft. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No — r <br /> If ares, spoils storage Location: abn�d <br /> a�cs.on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: Ei <br /> GROUTING or DESTRUCTION Total Depth: =_ <br /> Depth to Water: ft• tt. <br /> Grout Material: IWA Q rN� <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: \0-k5l 96\ <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation,WBoring Destruction , lot Size: <br /> Bags of Cement: <br /> METHOD USED �O`�o Bags Sand/Gravel: <br /> �X `�"�' Type/Brand of Bentonite: <br /> ❑Pressure Grout I�Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water CeVent 471" Water Cement 941b <br /> allons Noags gallons Bags <br /> Thickest Thinnest itBags 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 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />