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SAN JOAQUIN <br /> �wEnvironmental Health Department <br /> ---COUNTY <br /> ciFoaa�"' Greatness grows h,,t <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 46h? Inspector: SAM CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP#cmq� 1()2 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: <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 ASOVE-GROUND <br /> Holding Temperature: COWLEiION c�tFnoN <br /> Method: GroundSudw* + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> SPOILS tt. <br /> ft. <br /> SPOILS = <br /> = o <br /> Contamination Noted: ❑ Yes El No <br /> C <br /> If yes, spoils storage Location: alonad �:' <br /> wc:on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: _2 F _ <br /> Depth to Water: --4()% n• n' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation $Well 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 /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity KTremie ❑Other: Type of Method: <br /> Water ment 471b Water Cement 941b <br /> gallons Bas eallons Bags <br /> Thickest Thinnest u Thickest Thinnest bBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.s 5 1 11 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 1 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 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 />