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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> tiPa�la"/ Greatness grows her,,. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: �a17 A 4• CONSTRUCTION <br /> Facility Address: <br /> Well Address: - _6 0. c9k1 2. Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: 1 5 Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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 ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: cONPLETION COMPLEMN <br /> Method: Ground Surfacs <br /> Screening Method: 01 arm <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: abed <br /> Bacton <br /> Covered: ❑ Yes ❑No <br /> ack <br /> If yes, material: 'k <br /> GROUTING or DESTRUCTION Total Depth: 200 _ <br /> Depth to Water: F IF <br /> ��// ,f n n' <br /> Grout Material: �PiY1 V�• 7' SO r93 MATERIALS DEVELOPMENT <br /> Gallons of Grout Used: 7c29-all 0!- <br /> Casing Type: <br /> ell Installation Installation ❑Well Destruction Blank Feet Screen 7 Feet � • <br /> Slot Size: <br /> [-]Boring Installation ❑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 ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest zBags Thickest Thinnest VBags 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 (� C <br /> 12.5 25 s zs 50 s �g s �T G��lf �✓2� ( C s� �b S <br /> 15 30 6 30 60 6 <br /> IL <br /> 17.5 35 7 35 70 7 <br /> 200 40 8 40 80 8 �� Q,1r10-J\ Q <br /> ll0 / 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 />