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SAN-JOAQUIN <br /> i r —COUNTY Environmental Health Department <br /> Gr-eutness grows here <br /> �/ Monitoring Well/Soil Boring Inspection Report <br /> L1y� <br /> Date: � .� a Inspector: �l V\(}�• CONSTRUCTION �j��(n \ 2 <br /> Facility Address: -r3�(n <br /> Well Address: Total Depth:r <br /> WP# 0() U "'VWell#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: EW- S60(1 <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: 111 <br /> height <br /> SAMPLING ABOVE-GROUND CHR__ <br /> Holding Temperature: COMPLETION coMPLEnoN <br /> Method: Ground Strfacn <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —`--tt' <br /> tt. <br /> ft. <br /> SPOILS = <br /> = m <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes, spoils storage Location: slotted <br /> "cion <br /> Covered: ❑ Yes ❑No <- _ g-V'+Pack <br /> If yes, material: 1 I <br /> I5 <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: /v' tt• — tt' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: "t t , <br /> i Casing Type: <br /> ❑Well Installation ❑Well Destruction l b Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installationoring Destruction "(3 �'` J 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 ❑Tremie_ ❑Other: Type of Method: <br /> Water Ceent 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest gs Thickest Thinnest uBaBs 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />