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SAN JOAQUIN <br /> Environmental Health Department <br /> %!fa ' COUNT Y— <br /> Grectness qro;+•s here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7 Inspector: Nr1sf CONSTRUCTION <br /> Facility Address: g �S <br /> Well Address: Total Depth: <br /> WP#,a!5,39/fl2_ Well#: Drilling Rig Type: f E <br /> Soil Boring#: S/ <br /> Drilling Company:. Env Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> g p y fid �•Z4'� <br /> Driller Onsite: /��r�'�c,Eo Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: G 7`Z <br /> Geologist: TFhn._ « 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: T height <br /> iii ♦ � <br /> SAMPLING ABOVE-GRWND CHR IS N- <br /> Box <br /> Temperature: COWPLETION COMPLETION <br /> Method: Ground Sumacs <br /> Screening Method: armn <br /> Verified Chain of Custody: ❑ Yes [I No ft. <br /> tt. <br /> tt. <br /> SPOILS a. <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: sbtad <br /> sac5on <br /> Covered: ElYes ❑No <br /> :°r'. — gravel pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: — <br /> Depth to Water: O e) v`ar -le r <br /> Grout Material: N !!tf" e*efke,&, <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation IRBoring 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 /> aterC ent 71b water Cement 94 lb <br /> allo Ba 5,- gallons Bags <br /> Thic est Thinnest #Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 40 80 8 <br /> TV Z2 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />