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SANdOAQUIN Environmental Health Department <br /> —•COUNTY— <br /> �OHc.r�c,=` ' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: /7ej Inspector CONSTRUCTION <br /> Facility Address; S <jti'dc <br /> Well Address: / Total Depth: <br /> WP# l L� Well#: Drilling Rig Type: <br /> Soil Boring#: _ Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company; Screen Length From: To: <br /> ConsulDriller Cant:onsi : Filter Pack From: To; <br /> Geologist: fit% Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes []No COMPLETION [IS tove Pipe El Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing . <br /> If yes,location and distance: <br /> SAMPLING ABOVIKSOUND <br /> cOWLHT1014 7 Y sox <br /> Holding Temperature: cr�aPt;_rivN <br /> Method: — GmUnasuriaca <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑No ' <br /> tt. <br /> SPOILS ft. <br /> Contamination Noted: ElYes ❑No V� " <br /> If yes,spoils storage Location: <br /> alastati N <br /> •� c <br /> saa'aan . i � <br /> Covered: El Yes ❑No �� I <br /> If yes, material: <br /> GROUTING-or-DESTRUCTION.Total Depth:.- <br /> Depth to Water: - t. <br /> Grout Material: _ ��' MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation �QNell Destruction Blank Feet Screen Feet <br /> Slot Size:- <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel; <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity [wrremie 4Other: � �. Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Ba allons Bags <br /> Thickest Thinnest NBags Thlcke5t Thinnest NBags BentoniteXement)it+9ix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.411 2.47 <br /> 5 10 2 10 j 20 2 Bentonite per 94 lb 2.821 4.7 <br /> 75 15 3 15 30 a , , i i <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 7 e wrl /r <br /> 15 30 6. 30 60 6 J <br /> 17.5 35 7 35 70 7 /y/4 <br /> 20 40 8 40 80 0 � '�/�% / _/ <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95206 1 T 209 468-3420 1 F 209 464-0138.1 www.sicehd.com <br />