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SA N. J OAQ U I N Environmental Health Department <br /> C, --COUNTY— <br /> Greatness <br /> COUNTYGreatness grows here. <br /> '^ Monitoring Well/Soil Boring Inspection Report <br /> Date:16 22 f/TQ Inspector: /0. 4 , CONSTRUCTION <br /> Facility Address: <br /> Well Address, Total Depth: <br /> WP# 00q() Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: � 'y, Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: G Co Filter Pack From: To: <br /> Geologist: �/ r(_ o t� <br /> 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: WT <br /> height <br /> SAMPLING ABC)VE-GROUND <br /> Holding Temperature: COMPLETION C�rLE77oN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> n. <br /> ft. <br /> SPOILS = <br /> = m <br /> Contamination Noted: ❑ Yes El NoAr <br /> = <br /> If yes, spoils storage Location: <br /> stoned <br /> Covered: ❑ Yes []No = a-vu+pack <br /> If yes, material: % <br /> GROUTING or DESTRUCTION Total Depth:AOLEf . =_ <br /> Depth to Water: n• tt. <br /> Grout Material:— ± MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 68 a <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity t�.Tremie ❑Other: Type of Method: <br /> Water Ceme 471b Water Cement 941b <br /> allons Bas iRall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest J: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 /> 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 40 8 40 80 8 <br /> I 0 0,/16a,gs 10/16/2017 <br /> 1`868 E. Nzelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />