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- ' SAN JOAQUIN Enviro <br /> nmental Health Department <br /> COUNTY <br /> Greotne s crmvs tier,. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: S-' I j rl,s CONSTRUCTION <br /> Facility Address: I r <br /> Well Address: Total Depth: <br /> WP# 'O_ � 0 Well#: Drilling Rig Type: <br /> Soil Boring#: CPT 2 Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: MIAtile, eur+f\. <br /> Driller Onsite: , Vj'Y\ Screen Length From: To: <br /> Consultant: f re'" �iY�Vi(�ll ,Y I Filter Pack From: To: <br /> Geologist: py cr1 NW—rq Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND <br /> GOWPL.EMN C-RISTY-BOX <br /> Holding Temperature: CWPLETiON <br /> Method: G=nd Sur€acs <br /> Screening Method: V>ygrout <br /> Verified Chain of Custody: ❑ Yes El No ----n- <br /> ft. <br /> SPOILS ft' <br /> Contamination Noted: El Yes ❑No y _� <br /> If yes, spoils storage Location: <br /> stand � � <br /> Covered: ElYes ❑No soon _ <br /> If yes, material: <br /> GROUTING or-DESTRUCTION Total Depth: <br /> Depth to Water: <br /> .......__..ft. ft. <br /> Grout Material: MAE Gemt?nfi <br /> Gallons of Grout Used:_ N I 60� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation ®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 19Tremie ❑Other: Type of Method: <br /> Water Cem 47 <br /> Ba1b 'Hater Cement 941b <br /> gallons s allons Bags <br /> Thickest Thinnest e 5g__s Tf-jickest Thinnest 9 Bags Bentonite/Cement Mix 3°/o Mix 5% Mix <br /> 2.5 5 1 1 5 10 1 Bentonite per 47 lb 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />