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SAN JOAQUIN Environmen Health Department <br /> —COUNTY - <br /> r . <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: y� CONSTRUCTION <br /> Facility Address: # Je.. pr,,,_c g to 34 -1+� <br /> Well Address: V Total Depth: <br /> WP#evayy� Well#: Drilling Rig Type: <br /> Soil Boring#: (J ,Lj J% z(�W t� Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: B Screen Length From: To: <br /> Driller Onsite:� ,.,,. CJ <br /> Consultant:_f�a�..,(-.� Filter Pack From: To: <br /> M Bentonite From: To: <br /> Geologist: <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: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLEMN COMPLEMN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �---ft' <br /> fi. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes,spoils storage Location: sbttad <br /> sacaon '— � <br /> Covered: ❑ Yes ❑No _ <br /> If yes, material: x <br /> GROUTING or DESTRUCTION Total Depth: '�c�1, __ <br /> Depth to Water: ZA�,1 s gZ n <br /> Grout Material:T sa" 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 ring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity G].T-remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags pallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 i0 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 5 3 15 30 3 <br /> 10 12.5 25 5 25 500 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 Vv�� �Z I <br /> 20 40 8 40 80 8 �� 615 <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 />