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1 <br /> SANoJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report Iva <br /> Date4Addrss:: <br /> �Inspect r: v CONSTRUCTION e� �ea 3-ZZ <br /> Facility! <br /> Z39 �M1 Jrr v <br /> Well Address: MR/y I r✓� Total Depth: 6tt <br /> WP# L 0 Well#: Drilling Rig Type: C— <br /> Soil Boring#: R A Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: T C�a Screen Length From: To: <br /> Driller Onsite: n Filter Pack From: To: <br /> Consultant: Bentonite From: To: <br /> Geologist: Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No height:casing <br /> If yes,location and distance: <br /> SAMPLING ABOVE-GROUND �R�yeox <br /> COMPLETION COMPLETION <br /> Holding Temperature: Orosind S rlaca <br /> Method: T <br /> groutScreening Method: <br /> n. <br /> Verified Chain of Custody: ❑ Yes ❑No n. <br /> SPOILS =_ , <br /> .° <br /> Contamination Noted: El Yes ❑No � <br /> If yes,spoils storage Location: ■lottad <br /> sacilon ,I <br /> Covered: ❑ Yes ❑No = gmvW pack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth:_ <br /> Depth to Water: 35 <br /> Grout Material: e"� P t t" Ow MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 4 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> v Slot Size: <br /> ❑Boring Installation Spring Destruction Bags of Cement: <br /> METHOD USED / Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout <br /> �/0Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ',. Jremie ❑Other: Type of Method: <br /> Water ✓✓cement 471b Water cement 94lb <br /> allons Ba s allons Ba s _ <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags B43ntenitelCement MiX 3%MIX $%MIX <br /> 2.5 5 1 5 10 1 lBentonite per 47 Ib 11 2.47 _ <br /> 5 10 2 10 20 2 Bentonite per 94110 2.82 4.7 <br /> f 7.5 15 3 15 30 3 <br /> 9 V 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 24� 15 30 6 30 60 6 <br /> 17.5 35 35 70 7 <br /> 20 40 a 40 30 a 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 />