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` SANJOAQUIN Environmental Health Department <br /> ` COUNTY- <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: (f1CONSTRUCTION <br /> Facility Address: 910AIlft, O/v)f3 D10-'ri A-40 <br /> Well Address: Total Depth: <br /> WP# t7'ov Well#: Drilling Rig Type: <br /> Soil Boring#: �,F' � I ,p��( <br /> Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: y" Screen Length From: To: <br /> Driller Onsite: ,ti i-L k v <br /> Consultant: l.�l e� ,..1 (. r k . Filter Pack From: To: <br /> Geologist: 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: I T height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLEr ON comptEnoN <br /> Method: Gmund SWact <br /> Screening Method: ofOLn <br /> Verified Chain of Custody: ❑ Yes El No <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stottod <br /> sac�on _ <br /> Covered: ❑ Yes ❑NoZi = g-vw t <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth [� > �- <br /> Depth to Water: l2.-S` ` ' � <br /> Grout Material: 0 ("2 �' <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: —, t j,5 SaU ,, <br /> - <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation_?�oring Destruction <br /> 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 �remie []Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> Rall s Bas eallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 9Bags 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 /> 1 35 7 35 70 7 <br /> 20 40 40 80 8 <br /> 10/16/2017 <br /> Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />