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SAN JOAQUINJ Environmen . Health Department <br /> COUNTY <br /> �r <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: t(o Inspector: Le, a CONSTRUCTION <br /> Facility Address: "yap R-ot'-. (tA <br /> Well dress: Total Depth: <br /> WP# Do 3$`SWell#: MA%d% y(w)t(Aojq 4rilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: 6,"Vtv✓1 <br /> Min 2"Annular EHD Seal Verified: 11 Yes []No <br /> Driller Onsite: J'j Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: N�e�.,.,r+ 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: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION �L_-BOX <br /> Method: c3roundSuiact T <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> ft. <br /> SPOILS - <br /> Contamination Noted: ❑ Yes ❑No =` <br /> If yes,spoils storage Location: sbttQd <br /> sac9on — � <br /> Covered: ❑ Yes ❑No <br /> g-�o Pack <br /> If yes, material: ?' <br /> GROUTING or DESTRUCTION Total Depth: . __ <br /> Depth to Water:t(a06, � n- <br /> Grout Material: ,I\«•dam r MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 50 q <br /> Casing Type: <br /> ❑Well Installation rive?l Destruction Blank Feet Screen Feet <br /> ❑Boring Installation El Boring Destruction Slot Size: <br /> 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 /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest ttBags 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 50 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 0 W 4 f g Al 1 / <br /> �f vu 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 />