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SA N J OAQ U I N Environmental Health Department <br /> COUNTY <br /> „ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ti� � L Inspector: AAfin CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# e-'CZ'L/VePZ'1 Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> iJ <br /> Screen Length From: To: <br /> Driller Onsite: /Zc' <br /> Consultant: ACC/� <br /> Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE GROUND _ <br /> Holding Temperature: COMPLETION COMPLET <br /> ION <br /> Method: G=r)d Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No ft• <br /> ft. <br /> ft. <br /> SPOILS <br /> X.. <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> r <br /> S10 d <br /> Becton — <br /> Covered: ❑ Yes ❑No <br /> VIA+Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 7,1, <br /> a- <br /> Depth to Water: ft. <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ,Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity Zremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags Fallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 1 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 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 />