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SAN JOAQUIN <br /> COUNTY E[i11 i ror(11mentall Heap Department <br /> Greo'tness grows here, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: t Total Depth: <br /> WP# p Well#: Drilling Rig Type: <br /> Soil Boring#: 1. <br /> Drilling Company: Min 2"Annular FHD Seal Verified: El Yes ❑No <br /> Driller Onsite: r Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: r(! ' Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Wel10 nsite: ❑Yes ❑No cazing <br /> If yes, location and distance: height <br /> SAMPLING AWYE-GfICUND <br /> Holding Temperature: COWLE ION -sox <br /> Wt8�vN <br /> Method: + rya s <br /> Screening Method: Gtow <br /> Verified Chain of Custody: ❑ Yes El No ft- <br /> ___-»fie <br /> SPOILS J <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: :=r <br /> swan <br /> Covered: ❑Yes ❑No ` <br /> sr Pack <br /> If yes, material: <br /> GROUTING-or-DESTRUCTION.Total Depth: <br /> Depth to Water: ----� - '" �' • <br /> Grout Material; C044%i' MATERIALS/DEVELOPMENT <br /> of Grout Used:_ ^' 2 �►` Casing Type; <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Baring Installation ❑ Slot Size: <br /> Baring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout Dover Drill Type/Brand of Bentonite: <br /> Filter Pack TypeJSize: <br /> ❑ Gravity KTremie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 941b <br /> aHons Bags allnns Bags <br /> Thickest Thinnest t#B Thickest Thinnest Bags SentomiteXeme>nt Mix 3% Mix 51IA Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> s 1 a 10 0 2 <br /> 7.5 15 3 15 80 3 Bentonite per 94 Ib 2.82 4.7 <br /> •, � t i , <br /> 10 20 4 20 40 4 <br /> 12,5 25 5 25 50 5 <br /> 15 30 6 30 50 6 <br /> 17,5 35 7 35 70 7 <br /> 20 40 8 40 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468--3420 1 F 209 464-0138 www.sicehd.com <br />