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SAN JOAQUIN Environmental Health Department <br /> ----COUNTY-- <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ,S Inspector: CONSTRUCTION <br /> Facility Address: f3Z6 �J ft'r0 �C _ <br /> Well Address: Total Depth: <br /> WP#_'2S O0620 Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: U <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 11-P-4 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes,location and distance: height <br /> T <br /> W <br /> SAMPLING wsovE-GROUND <br /> Holding Temperature: °0��1ON COM LEMN <br /> Method: Ground Saf acs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> tt. <br /> SPOILS <br /> K. <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: slotted <br /> soon <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:: <br /> Depth to Water: —ft. 2 F — ft. <br /> Grout Material: <br /> Gallons of Grout Used: ^� 7j (' MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction rly)(A Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation' Boring 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 ❑Tremi ❑Other: Type of Method: <br /> Water ement 471b Water Cement 941b <br /> Ilons Bags 000 Railons Bags <br /> T ickest Thinnest Thickest Thinnest gBags Bentonlite/Cement Mix 3%Mix 5%Mix <br /> s 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />