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SQN JOQQUIN Environment Health Department <br /> —COUNTY— <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: S Z Inspector: I-, ��v CONSTRUCTION <br /> Facility Address: 14g! L4 [> / Ri <br /> Well Address: Total Depth: <br /> W P# ao3lo-ir' Well#: Drilling Rig Type: <br /> Soil Boring#: CT(rW L <br /> Drilling Company: ,Q Min 2" Annular EHD Seal Verified: El Yes El No <br /> Screen Length From: To: <br /> Driller Onsite: _�.�.. Filter Pack From: To: <br /> Consultant: C"' -Awc� <br /> Geologist: f��� pE <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: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION CCMPt. ON <br /> Method: G=nd Su 1.w_* <br /> Screening Method: or«n <br /> Verified Chain of Custody: ❑ Yes ❑No -�--n' <br /> ft. <br /> SPOILS = <br /> _ - o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stottgd <br /> sx�an >_ — <br /> Covered: ❑ Yes ❑No = r <br /> ack <br /> If yes, material: r _— <br /> GROUTING or DESTRUCTION Total Depth: �-6 <br /> Depth to Water: (.,a (-t- n• <br /> Grout Material: fvc-A- e MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation CA-bring 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 P41 remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Bags Fallon5 Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest riBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 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 6 30 60 6 <br /> 17.5 7 35 70 7 <br /> 20 40 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />