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.'ref nVi.y c., <br /> SANvJOAQUIN Environmental Health Department <br /> `J —COUNTY— <br /> '` y `' Greatness grows here, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: � Inspector: CONSTRUCTION <br /> Facility Address: o <br /> Well Address: Total Depth: <br /> WP# AW Well#: � �—� Drilling Rig Type: <br /> 'Soil Sor4 M� - `�-� in 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: <br /> 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 casing <br /> If yes, location and distance: W— T <br /> height <br /> SAMPLING AWE-6ROU rD <br /> Holding Temperature: Co&FLE'rloN COMPLETiON <br /> Method: Grocind Suiace <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Nott' <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No = z <br /> If yes,spoils storage Location: slotUd <br /> sscaon ��„ <br /> Covered: ❑ Yes ❑No = f Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: �� <br /> Depth to Water: <br /> Grout Material: v \ <br /> '���_ 0� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation GJWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation El 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 /> S l ;'`` Type of Method: <br /> El Gravity ElTremie C�lOther: - N� <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%MIX 5% MIX <br /> 2.s 5 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 5 8 15 30 3 <br /> 10 2 4 20 40 4 <br /> 12,5 5 25 50 5 <br /> 15 30 6 30 6o 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 />