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• • '�°�° SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> Ure'uh'less grows hey. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 Inspector: L CONSTRUCTION <br /> FacilitLAddreo <br /> s61 Acay <br /> Well Address: Total Depth: <br /> WP# OD3q Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2" Annular EHD Seal Verified: L-1Yes ❑No <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <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 casirg <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION CCWP=CN <br /> Method: Gmurid s"f"' <br /> Screening Method: gro(A <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> tt. <br /> h. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No — m <br /> If yes, spoils storage Location: abed <br /> aac'cn <br /> Covered: ❑ Yes ❑Nci <br /> If yes, material: <br /> —41() V 41 <br /> GROUTING or DESTRUCTION Total Depth: -_ <br /> Depth to Water: n <br /> Grout Material: <br /> 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 ❑Boring Destruction Bags of Cement: <br /> METHOD USED gj-�ou'L Ta/tf7vn WI&Bags Sand/Gravel: <br /> F-1 Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ' ,Tremie ❑Other: Type of Method: <br /> Water Ce ent 471b Water Cement 94 lb <br /> gallons gallons Bags <br /> Thickest Thinnest 1:Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 3% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 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 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 s 40 80 a <br /> 56 81 w/ 2115 j Vbw vow 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 />