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SKJOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: "V CONSTRUCTION <br /> Facility Address: AllSt ,3:&° <br /> Well Address: Total Depth: <br /> WP# 00 q Well#: Drilling Rig Type: <br /> Soil Boring#:�•� -3�f P-Y3 V 2� <<�_ Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: gr/! Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: �TGr�. <br /> Filter Pack From: To: <br /> Geologist: �,fil t 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 ABOVEGROUND <br /> COWLEfION C -BOX <br /> Holding Temperature: co1.OMPLE+PiEnoN <br /> Method: Ground svlan7+7 <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt• <br /> tt. <br /> SPOILS _ <br /> e <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: �brcud <br /> awc0on <br /> Covered: ❑ Yes []No <br /> pr�va7 park <br /> If yes, material: .a5; <br /> GROUTING or DESTRUCTION Total Depth: z,0 <br /> Depth to Water:___I,17, <br /> Grout Material: A)24 el <br /> Gallons of Grout Used: 5= G,,g/AAr MATERIALS/DEVELOPM ENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation PUBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> []Pressure Grout []Over Drill <br /> y Filter Pack Type/Size: <br /> ElO Gravity tTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags stallons Baes <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags BentonitefCement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47lb 1 1.411 2.47 <br /> 5 20 2 10 20 2 Bentonite per 94lb 1 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 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 />