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SAN JOAQUIN <br /> Environmen Health Department <br /> —COU NTY-- <br /> - Gr_ .. r . <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: .Shill-5hill Inspector: CONSTRUCTION <br /> Facility Address: N,- :j <br /> Well Address: Total Depth: <br /> WP# UO 3 l Well#: Drilling Rig Type: <br /> Soil Boring#: �L vJ l°I <br /> Drilling Company: r�✓ Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: �s —�o� Filter Pack From: To: <br /> � <br /> Geologist: 5c..n{# <br /> 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: T height <br /> 59 <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION COMP ON <br /> Method: G=r)d SuRacs <br /> Screening Method: I P" <br /> grart <br /> Verified Chain of Custody: ❑ Yes ❑No eft. <br /> tt. <br /> SPOILS <br /> — - o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slatted _ <br /> sac5on — <br /> Covered: ❑ Yes ❑No <br /> If yes, material: u <br /> GROUTING or DESTRUCTION Total Depth: — <br /> Depth to Water: 40!Fb ft• IF <br /> Grout Material: rle—t- CUtiPr-� <br /> Gallons of Grout Used: �l0 '♦—t,,� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tf remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> pall s Bags Fallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> s 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 /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 G <br /> 17.5 35 7 35 70 7 J <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> vo <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />