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SANGJOAQUIN <br /> ' Environmental Health Department <br /> COUNTY— p <br /> ✓rX <br /> • �Oy4,Fss,Y? Gretrtnass grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z 12 2'� Inspector: _ CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# Weil#: Drilling Rig Type; <br /> Soil Boring#: W 2 Z_ S Drilling Company: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: tilvymanyd Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No Casing <br /> If yes, location and distance: height ' <br /> W- T <br /> SAMPLING _ RsovE•i;�louNo W'MTilaox <br /> COMPLEf10N <br /> Holding Temperature: coMPtETtoN <br /> Method: Ciro <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑No + R <br /> SPOILS _--, - <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> abttad .• s � <br /> Covered: ❑Yes ❑No Wa on <br /> If yes,material: <br /> GROUTING-or-DESTRUCTION Total Depth:--Zl...-•.. <br /> Depth to Water: is tt- <br /> GroutMaterial: vuf'} ePj1(f"fi1� - MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: socliAt• Casing Type: <br /> ❑Well Installation AWell Destruction CNW , Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED .A rii koir S r rl• Bags Sand/Gravel: <br /> 7" Type/Brand of Bentonite: <br /> re Filter Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ®Sremie ❑Other: Type of Method: <br /> Water ent471 Water Cament941b <br /> gallons Ba s gallons Bags <br /> Thldmt Thiest nn age Thlrkest Thfonest #Bags Bentonite/Cement Mix 3%MIX 5%Mix <br /> 2s s 1 1 5 10 1 Bentonite per 47lb 1 1.411 2.47 <br /> 5 20 2 1 11 10 1 20 1 2 Bentonite per94lb 1 2.821 4.7 <br /> 7.5 15 3 is 80 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 3o 6 3o 60 6 <br /> 17.5 85 7 35 70 7 <br /> 20 40 8 40 <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 />