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/hau4V SAN�JOAQUIN , � EnvironmerA lI Health Department <br /> —COUNTY— <br /> •.ct„_;_�,,•' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: V.` Inspector: CONSTRUCTION <br /> Facility Address: %Wgab BOA <br /> Total Depth: <br /> Well Address: �°�-- <br /> WP# % \h Well#: Mw ' d Drilling Rig Type: <br /> Soil Boring#: �� I� Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: rt- Filter Pack From: To: <br /> Consultant: `K"'�t­ Bentonite From: To: <br /> Geologist: -`' �10 `' Grout From: To: <br /> Public Water System Onsite: El Yes �RNo <br /> COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes NO � casing_ � height <br /> If yes, location and distance: -, <br /> SAMPLING Asa�-eaOUND q.RMY.8ox <br /> COMPLETION COMPLEr10N <br /> Holding Temperature: c3r°dndSurfc <br /> Method: ors <br /> Screening Method: �_tt• <br /> Verified Chain of Custody: ❑ Yes ❑No tt• <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = .. o <br /> If yes, spoils storage Location: sl°tt°d = A <br /> action ty <br /> Covered: ElYes ❑No n _ gram Facts <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_L\ nIJ, <br /> Depth to Water: GrQ <br /> Grout Material: 'o V-4e' Ll r"' � MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> Blank Feet Screen Feet <br /> ❑Well Installation rJellDestruction Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> *ressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity �Tremie ❑Other: <br /> Type of Method: <br /> water Cement 47lb water cement 941b <br /> allons Be s allons Ba <br /> Thickest Thinnest a Bags _ BentonitelCernent Mix 3% Mix 5% Mix <br /> Thid;est Thinnest geags Bentonite per 41 Ib 1.41 2.47 <br /> 2.5 s 10 1 2.82 4.7 <br /> 5 10 s 10 20 2 Bentonite per 941b <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 a 30 00 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 40 6 40 80 0 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www sip com <br />