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SAN .IOAQUIN <br /> Environmental Health Department <br /> Greatness grows here. <br /> Monitoring <br /> Well/Soil Boring Inspection Report <br /> Date:/ O <br /> " / / Inspector: Q`1�/a r J CONSTRUCTION <br /> Facility Address: <br /> Well Address: y y L Total Depth: n <br /> WP# d d 3 9 4y 2, ' h/ell#: ( Drilling Rig Type: oZ 4S A <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: K n <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Coerp g 1-0k-L Zl Filter Pack From: To: <br /> Geologist: —7S a4p,0-4 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 /> Holding Temperature: COMPLETION noN <br /> Method: GroundSaiacs 7 <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No Ii, <br /> ft. <br /> ft. <br /> SPOILS r <br /> Contamination Noted: ❑ Yes ❑No ` <br /> t' C <br /> If yes, spoils storage Location: sion.d <br /> sacdon <br /> Covered: ❑ Yes ❑No g-vW pack <br /> y' <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ft JL <br /> Grout Material: <br /> Gallons of Grout Used: 1d0 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction gags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> 'VGravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cemen 941b <br /> allons Bas gall ons Bags <br /> Thickest Thinnest xBags 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 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 /> 125 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 /> B� P-I <br /> 10 <br /> ! 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />