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SANJOAQUIN Environmental Health Department <br /> i ift`1i` j — COUNTY— <br /> °�cr ocl`•° ' Greatness groves here. <br /> Monitoring Well /Soil Boring Inspection Report <br /> Date : I Inspector : S I't S.� y01l ' CONSTRUCTION <br /> Facility Address : <br /> Well Address : Total Depth : <br /> WP# Dog 1345 Well#: S4 — 1l— Drilling Rig Type : <br /> Soil Boring# : Min 2" Annular EHD Seal Verified : ❑ Yes [] No <br /> Drilling Company : e ✓ Screen Length From : To : <br /> Driller Onsite : <br /> Consultant: A 1/ . Oeo _ <br /> 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 Ll No east ng <br /> If yes, location and distance : height <br /> SAMPLING �tsovraourta <br /> Holding Temperature : »t toN c4vusMc ON <br /> - - - - _- <br /> — Method - - - - - - [ic«;nasurx, -- - - ---_- - — - <br /> .�.�..�. <br /> if <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes El No ft- <br /> fL <br /> fi. <br /> SPOILS <br /> Contamination Noted : Yes El No <br /> If yes, spoils storage Location : ston�o <br /> Covered : )Yes ❑ No <br /> If yes, material : <br /> GROUTING or DESTRUCTION Total Depth : ,SS <br /> Depth to Water : <br /> Grout Material : z5p o beq*1 i <br /> Gallons of Grout Used : oo . 0 2r4(6 MATERIALS /DEVELOPMENT <br /> Casing Type : <br /> [] Well Installation . oN& II 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 XTremie ❑ Other : Type of Method : <br /> Water Cement 47 lb Water Cement941b <br /> gallons Bas qallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest # Bags BentonitelGement Mix 3 % Mix rJ %o Mix <br /> z. s s 1 s 10 1 Dentonite per 47 lb 1 .41 2 .47 <br /> s to z 10 za z Bentonite per 941b 2 . 82 4 . 7 <br /> 7.5 15 3 15 30 3 <br /> 10 10 4 20 40 4 <br /> 12, 5 25 1 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17, 5 35 7 35 70 7 <br /> 20 40 1 40 80 8 <br /> Mw <br /> 10/ 16/2017 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 F 209 464- 0138 www. sicehd . com <br />