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SANJOAQUIN <br /> 3 .�".� —COUNTY— p Environmental Health Department <br /> t; <br /> � . <br /> •\O74�rix+s�`p Greatness grows here. I <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspect r: CONSTRUCTION <br /> Facility A dr ss: 3 1 <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> i <br /> Soil Boring#: 3 — 8H Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: IS C i <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: �nQ,eYi� Filter Pack From: To: <br /> Geologist: j(,�� N� t t Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: El Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑Yes []No ageing <br /> If yes,location and distance: hai8ht ' <br /> SAMPLING �py€��! o "SOP <br /> Holding Temperature: coMaLEiunv COMPLETION <br /> Method: -- cf«nasutaca <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑No 4r —ft• <br /> SPOILS c <br /> o . <br /> Contamination Noted: ❑Yes ❑No 9 <br /> If yes,spoils storage Location: alonad `c _ s <br /> aocaon .8 <br /> Covered: ❑Yes ❑No <br /> If yes,material: <br /> I <br /> GROUTING-or-DESTRUCTION.Total Depth: ,•: <br /> Depth to Water: Wafer, - A tt ft• <br /> Grout Material: Npr MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:�"_� <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring InstallationB Slot Size:oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> []Pressure Grout Dover Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> f gravity ❑Tre 'e ❑Other: — Type of Method: - - - - <br /> Water ement 471b Water Cement9411a <br /> a Ions I Ba s eallons Be s <br /> MIS <br /> Thinnest #Ba Thickest Thinnest ABags Bentonitelcement Mix 3%Mix 5%MIXI. <br /> 5 1 s 10 1 Bentonite per 471b 141 2 47 <br /> 10 2 10 z0 2 Bentonite per 941b 2.82 4.7 <br /> 15 3 Is 30 3 , , , <br /> 10 20 4 20 40 4 <br /> 12.5 1 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 5..5 1 35 7 35 70 7 <br /> 20 1 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 />