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SAN-JOAQUIN <br /> j_-'G <br /> C 0 U NTY— Environmental Health ®apartment <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector CONSTRUCTION <br /> Facility a' v i c <br /> Well Addr s Total Depth: <br /> WP# Well#: A7 /&,3 Drilling Rig Type: <br /> Soil Boringt Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company; ` <br /> Driller Onsite: QOWEL4V Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: „4_ Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christle Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes,location and distance: r n� <br /> SAMPLING in <br /> 1tBC31r;»�{�t3Ut•7A r..t�rsTY=sox ' <br /> Holding Temperature: CPloN <br /> Method: �r�s���m� <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑Yes ❑Noft• <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No " <br /> If yes,spoils storage Location: s <br /> Won" <br /> sate <br /> Covered: El Yes ❑Na <br /> g- Pack <br /> If yes, material: <br /> GROUTING-or-DESTRUCTION. Total Depth: =C <br /> Depth to Water; - " " • <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation kWell Destruction Blank Feet Screen Feet <br /> El Boring Installation ❑ Slot Size:- <br /> Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ElGravity PTremie Other: : /5 ' Type of Method: <br /> Water Cement 471b Water Cement 94111 <br /> gallons Bags allons Bags <br /> Thickest Thinnest 11Bags Thickest Thinnest 4Bags SentonitelComent Mix 3%Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 25 5 25 50 5 <br /> is <br /> 15 30 6, 30 60 6 <br /> 1715 35 7 35 70 7 <br /> 20 40 1 8 1 40 80 B _ �L1' ` <br /> 10/16/2017 <br /> 1868 E.Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138.1 www.sicehd.com <br />