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Q <br /> SAN J OAQ U I N Environmental Health Department <br /> COUNTY— <br /> Greatness <br /> OUNTY— <br /> Greatness grows here. <br /> y M i nitoring Well/Soil Boring Inspection Report <br /> Date: j� / 9 Inspector: I j A . CONSTRUCTION <br /> Facility Address: ut-W- C /}PQ <br /> Well Address: Total Depth: [r <br /> WP# 00 S Well#: Drilling Rig Type: <br /> Soil Boring#: tr,- Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite: p kVI t Screen Length From: To: <br /> Consultant: {-6- Filter Pack From: To: <br /> Geologist: /I Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLE ION ;=noN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes 0 N �--n' <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No r` <br /> If yes,spoils storage Location: atottad <br /> I r ( sacJon <br /> Covered: ❑ Yes ❑No <br /> pr,wt pack <br /> If yes, material: r <br /> GROUTING or DESTRUCTION Total Depth:3L T <br /> Depth to Water: AArri� r n- tt. <br /> Grout Material: <br /> Gallons of Grout Used: 2g2 da 1Io/15 MATERIALS DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation'f�rBoring Destruction Slot Size: <br /> 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 Cemen 471b Water Cement 941b <br /> allons Billons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mx 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 /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 1 40 8 40 80 8 <br /> (190-1 bo S 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stock on, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />