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i � <br /> SANdOAQUIN EnvironmenLcil Health Department <br /> —COUNTY— <br /> Grentness grows here. <br /> -� Monitoring Well/Soil Boring Inspection Report <br /> I <br /> Date: V I Inspect r: CONSTRUCTION <br /> Facility Address: eor- fv r <br /> Well Address: ( G ° Total Depth: <br /> WP# 6 Well#: I Drilling Rig Type: <br /> Soil Boring#: I A Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company J2� <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: `t -s Filter Pack From: To: <br /> Geologist: ��/ Qf k Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: lFal <br /> height <br /> SAMPLING ABOVE-GROUND CHRtmaox <br /> Holding Temperature: COWPLETION — -COMM-P-LEEnnOIN� <br /> Method: Gra,ntlsutac. grow n S� <br /> Screening Method: ' <br /> Verified Chain of Custody: El Yes <br /> ]No <br /> SPOILS <br /> J Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> slatted S"i = 8` <br /> w don <br /> Covered: ❑ Yes El No — gram P'4K <br /> If yes,material: I _ <br /> GROUTING or DESTRUCTION Total 4epth: ^ <br /> 1 = ' <br /> Depth to Water: `J� n• tt. <br /> Grout Material: 1A MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑ ❑ <br /> Boring Installation Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout 0 ver Drill Filter Pack Type/Size: <br /> ❑ Gravity �remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags allons aps <br /> Thickest Thinnest kBags Thickest Thinnest pBags 1113entonlitei ement Mix 3% Mix 5%MIX <br /> 25 5 1 5 10 1 Bentonite per 47lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 120 35 7 35 70 <br /> 20 <br /> 40 6 40 BO <br /> �0 10/16/2017 <br /> 1868 E. Hazeiton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />