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SAN J U AQ U I N Environmental Health Department <br /> r <br /> —COUNTY— <br /> Greatness grows here. <br /> Monit`—o�riinggWell/Soil Boring Inspection Report <br /> Date:7'Z6'Za Inspector: N!�` " . CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# �;22' /?( Well#: Drilling Rig Type: <br /> Soil Boring#:^,�—Ow <br /> Drilling Company: C./PaY a� /�%r <`y Min 2" Annular EHD Seal Verified: El Yes 11 No <br /> Driller Onsite: <br /> � Screen Length From: To: <br /> Consultant: NS Filter Pack From: To: <br /> Geologist: 00 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes E]No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE.GROUND _ <br /> Holding Temperature: COMPLETION CC#AP.EnoN <br /> Method: Ground Suiacs <br /> Screening Method: groud <br /> Verified Chain of Custody: ❑ Yes El No �f' <br /> ft. <br /> it. <br /> SPOILS <br /> — a <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: ato"d <br /> a <br /> an <br /> Covered: El Yes ❑No gni,;W p..k <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: --,` n- .. n' <br /> Grout Material: /✓et CE',tt-7 <br /> Gallons of Grout Used: -3, q(0 <X,/�s MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ��//II Slot Size: <br /> ❑Boring Installation 54oring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout�❑Over Drill Filter Pack Type/Size: <br /> El Gravity Lw'/fremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas Rall ons Bags <br /> Thickest Thinnest RBags Thickest Thinnest ABags 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 1 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 1 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 209 464-0138 1 www.sicehd.com <br />