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SM-JOAQUIN <br /> Environmental Health Department <br /> —COUNTY <br /> Greatness grows fere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: W// f /$ Inspector: Lar )(,o CONSTRUCTION T <br /> Facility Address: F-kO ti &-, td 4S-4eA^AAL. J <br /> Well Address: Total Depth: <br /> WP# OD 38-7'7 I Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: ❑ Yes 0 N <br /> Drilling Company:-_J tl�.. <br /> Driller Onsite: Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <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 /> swx <br /> Holding Temperature: CO �"'LE�N C*AP=0N <br /> Method: Gn7ind Surfacs <br /> Screening Method: o*� <br /> Verified Chain of Custody: ❑ Yes ❑No f' <br /> ct. <br /> fi. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: <br /> Covered: ❑ Yes ❑No = f,—V'4rz­" <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:HA ,j";)-P&6- <br /> Depth to Water: b <br /> Grout Material: rtr.�— c, MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: d <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Borin Installation Slot Size: <br /> g (ring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> R"Gravity <br /> Pack Type/Size: <br /> +L�Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas wallons Bags <br /> Thickest Thinnest "Bags 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' z 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 F <br /> 10 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 />