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SANdOAQUIN <br /> a Environmental Health Department <br /> —COUNTY <br /> \c�tP Greatness grows here <br /> /' pp Monitoring Well/Soil Boring Inspection Report <br /> Date: b 2� I Inspector: SUy_ ,rktA CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# 00 3 Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes E]No <br /> Drilling Company: SMOVA `$ <br /> Driller Onsite: 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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND <br /> CHMHolding Temperature: COWLEnON c PL�_EnoN <br /> Method: GewneSurfacs T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt. <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: atottod <br /> &action <br /> Covered: ❑ Yes El No <br /> If yes, material: <br /> ROUTIN or DESTRUCTION Total Depth: <br /> Depth to Water: tt• ' — tt- <br /> Grout Material: QIAJ ' LA MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity MTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest #Bags 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 /> s 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 /> 12.5 25 5 25 50 5 <br /> 155 30 6 30 60 6 �� I���j�� V\j r 2� OL <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 I www.sicehd.com <br />