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SANJOAQUIN Environmental Health Department <br /> —COUNTY <br /> Monitlo�ri�ng Well/Soil Boring Inspection Report <br /> Date: J nspe tor: VV ( � CONSTRUCTION <br /> Facility Address 1 <br /> Well Addrss: Total Depth: <br /> � <br /> WP# W II#: Drilling Rig Type: <br /> Soil Boring#: (f✓).�'� <br /> Min 2"Annular EHD Seal Verified: ElYes []No <br /> Drilling Company: VA <br /> raS n } <br /> Driller Onsite: I -# <br /> b.c 3.S>Screen Length From: To: <br /> Consultant: itf __ Filter Pack From: To: <br /> Geologist: L/ Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO 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: COWPLEr10N CccmptEnoN <br /> Method: Ground sunx..�------ <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> fl. <br /> tt. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = r <br /> If yes,spoils storage Location: abttad = B <br /> Bacton <br /> Covered: ❑Yes ONO = g„w <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: A =_ <br /> Depth to Water: n' <br /> Grout Material: ' h �r�y <br /> Gallons of Grout Used: cj n��`MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction � (�P� Blank Feet Screen Feet <br /> ❑Boring InstallationloBoring Destruction W `�► Slot Size: <br /> 'N Bags of Cement: <br /> METHOD USED \ tn`j Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Si -P,_ Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> �ravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons BasNThickest <br /> ns Bags <br /> Thickest Thinnest #Bags Thinnest 9Bags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 2.5 5 1 10 1 Bentonite er 47 Ib 1.41 2.47 <br /> 5 10 2 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 30 3 <br /> 10 20 4 40 4 <br /> 12.5 25 1 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 /> G1GO G( L1� `� 10/16/2017 <br /> 1868 E.Zzelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />