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SAR JOAQUIN <br /> I t ;pp Environmental Health Department <br /> 1� � —COUNTY— <br /> •\ 4+�ri i" Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �Inspector: I hQ CONSTRUCTION <br /> 50� <br /> Facility Addr ss: ft-nmg-A TA <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#:Drilling Company: Min 2"Annular EHD Seal Verified: ❑Yes ❑No Driller Onsite: C 8 Screen Length From: 15 To: 1 <br /> la <br /> Filter Pack From:_ To: <br /> Consultant: �' EG �, <br /> Geologist: 44 Bentonite From: To: 6 _ <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe *hhristie Box <br /> Domestic Well Onsite: ❑Yes ❑No aasin8 <br /> If yes,location and distance: height <br /> W- T' <br /> —GW* <br /> SAMPLING asovsr3FlOMo caiRmry-sox <br /> Holding Temperature: CO iETk'N ComptaTtoN <br /> Method: <br /> Screening Method: prom 6 III n t <br /> Verified Chain of Custody: ❑Yes ❑No <br /> SPOILS = 71 <br /> 2 v <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> Covered: ❑Yes ❑No 71 <br /> If yes,material: <br /> GROUTING-or-DESTRUCTION-Total Depth:--- -•-• _ . s; ,,. j <br /> Depth to Water: -� 'n• <br /> Grout Material -- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> Kwell Installation ❑Well Destrucg ion Blank Feet Screen - _ Feet <br /> V \. 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 /> VGravlty ❑Tremie ❑Other: - -Type of Method-- - - <br /> Water C ent 4716 Water Cement 94lb <br /> a Ions Be gallons Bags <br /> Thickest A408 <br /> Thickest Thinnest NBags 13entonitelCeimentMix 3 Mix 5°foRt1iX <br /> z,s 5 10 1 Bentonite per471b 1Al 2.47 <br /> 5 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3o 8 , <br /> 10 20 40 4 <br /> 12.5 25 50 5 <br /> is 30 60 6 . <br /> 17.5 35 70 7 <br /> 20 40 80 8 • <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95206 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />