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..`.Y � SAN J OAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> Greatness grows here . <br /> Monitoring Well /Soil Boring Inspection Report <br /> r t <br /> Date : r Z � Inspector : v � `�� CONSTRUCTION <br /> Facility Address : Yol ET'Povd;) r7 //b <br /> Well Address : Total Depth : <br /> WP# 0 30o () Well # : {Zf " �� Drilling Rig Type : <br /> Soil Boring# : Min 2" Annular EHD Seal Verified : ❑ Yes ❑ No <br /> Drilling Company : cc) (pi � � ��► <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 ❑ No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes ❑ No <br /> Iasi n4 g <br /> If yes, location and distance : -eight <br /> SAMPLING ABOVE�6RCVND <br /> Holding Temperature : COVPLRxaN <br /> Method : � nds�� <br /> Screening Method : p t <br /> Verified Chain of Custody : ❑ Yes El No -- -- - <br /> ft- <br /> SPOILS - <br /> Contamination Noted : ❑ Yes ❑ No <br /> � C <br /> If yes, spoils storage Location : <br /> Covered : ❑ Yes ❑ No Y: — <br /> If yes , material : ' <br /> Total Depth : <br /> GROUTING or DESTRUCTION <br /> a,. <br /> Depth to Water : NU �v e ft- <br /> Grout Material : _ 774.2 ,. t C (f61 MATERIALS / DEVELOPMENT <br /> Gallons of Grout Used : <br /> Casing Type : <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> El Boring Installation )K`6Slot Size : <br /> oring Destruction Bags Sizes <br /> Cement : <br /> METHOD USED Bags Sand /Gravel : <br /> Type/ Brand of Bentonite : <br /> ❑ Pressure Grout ❑ Over Drill Filter Pack Type/Size : <br /> Gravity ❑ Tremie ❑ Other : Type of Method : <br /> }Nater Cement 471b Water Cement 941b <br /> Railons Bas crallons 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 /> 510 z 10 zo 2 Bentonite per 94 Ib 2 . 82 4 . 7 <br /> 7. 5 15 1 3 15 30 3 <br /> 10 20 1 4 20 40 4 <br /> 12. 5 25 1 5 25 50 5 <br /> 15 30 1 6 30 60 6 <br /> 17. 5 35 1 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/ 16/2017 <br /> 1868 E . Hazeltan Avenue Stockton , California 95205 ( T 209 468 -3420 ( F 209 464 -0138 ( www . sicehd . com <br />