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SAN JOAQUIN <br /> Environmental Health Department <br /> 4_-_ —COUNTY <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Dater Inspector: 2e CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> ��,,,,, �` Screen Length From: To: <br /> Driller Onsite:���n��,y <br /> Consultant: C,Q.� <br /> Bentonite From: To: <br /> Filter Pack From: To: <br /> Geologist: PSIS <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> T,F6 -WW, <br /> SAMPLING J1SOVE-GROUND <br /> Holding Temperature: C°M?LErION CCWP=j CN <br /> Method: Ground Suiacs <br /> Screening Method: gr«n <br /> Verified Chain of Custody: ElYes 11 No �ft. <br /> 93- <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No `fit <br /> If yes, spoils storage Location: <br /> sacc n <br /> Covered: ❑ Yes []No Q�— l� t✓ <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> 2IF <br /> � <br /> Depth to Water: h W vi, I Ig T r IF <br /> n n' <br /> Grout Material: 61t mew t <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation*oring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout []Over Drill Filter Pack Type/Size: <br /> ❑ Gravity remie ❑Other: Type of Method: <br /> Water ment 471 Water Cement 94 It <br /> allonsgallons Bags <br /> Fck, Thinnest 1:Bags Thickest Thinnest :Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 15 3 15 3010 20 4 20 40 4 3 <br /> 12.5 25 5 25 `W` CaJ- <br /> 12.5 5 1 b�ltAS vV/ J��11V�W1►" <br /> 15 30 6 30 60 6 J �� <br /> 17.5 35 7 35 70 7 /yy�('j7� / ( ; I� ./ <br /> 20 40 8 40 80 8 �3 — —� (/\1/ �1�/Lt5/ (t"%6vja4,,t1 <br /> � "'1�. <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 F 209 464-0138 1 www.sicehd.com \J <br />