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SAN JOAQUIN Environmental Health Department <br /> COUNTY-- <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7/�I Inspector. ' CONSTRUCTION <br /> Facility Address: 6-c—)e 1:.w <br /> Well Address: Total Depth: <br /> WP# JD 3T V ell Well#: Drilling Rig Type: <br /> Soil Boring#:_, Z, <br /> Drilling Company: •,/�j W Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> �z a K <br /> Screen Length From: To: <br /> Driller Onsite: <br /> yVA//qtr KkOi Filter Pack From: To: <br /> Consultant: <br /> Geologist: .Tl� 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 El No casing <br /> If yes, location and distance: height <br /> _q W� T <br /> SAMPLING wscvs-GFICUND <br /> OX <br /> Holding Temperature: CONPLE'NON CCfAPtET(�CN <br /> Method: Ground Sutacs <br /> Screening Method: groan <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> SPOILS = <br /> = a <br /> Contamination Noted: ❑ Yes El No = <br /> If yes, spoils storage Location: alottad _ Z <br /> a :cn = <br /> Covered: ❑ Yes ❑No �, d <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tt tt' <br /> Grout Material: (1 y� C�f<`n�w <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 InstallationJ�Boring Destruction 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 ❑Tremie 1%Other�'fa11 Type of Method:_ <br /> ater a nt47 Water Cement 941b <br /> alto Bas Rall ons Bags <br /> Th c est Thinnest tt Bags Thickest Thinnest =Bass Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2,5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 1e zo 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 1 60 6 <br /> 1 71.5 35 7 35 1 70 <br /> 20 40 8 40 80 E <br /> i � 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 />