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t <br /> SAN JOAQUIN ° Environmental Health Department <br /> —COUNTY-- <br /> (;reatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date Z0'&20 Inspector: A'4&6"" CONSTRUCTION <br /> Facility Address: 2-4/" <br /> Well Address: Total Depth: <br /> WP#t��� Well#:/��'� Drilling Rig Type: �E � <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ElYes ❑No <br /> Drilling Company' Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: Bentonite From: To: <br /> Geologist:Areyz Grout From: To: <br /> Public Water System Onsite: ❑Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ONO casing <br /> -_P height _ <br /> If yes,location and distance: <br /> SAMPLING ABOVEGROUND IT <br /> COWLEnON COMPLEnoN <br /> Holding Temperature: Gnou d S�naa4 <br /> Method: oro,rt <br /> Screening Method: <br /> n. <br /> Verified Chain of Custody: ❑Yes ONO n. <br /> SPOILS -_ o <br /> ONO <br /> Contamination Noted: ❑ Yes <br /> If yes,spoils storage Location: 81enae c 8` <br /> section <br /> Covered: ❑ Yes ONO y.vdoax <br /> If yes, material: <br /> t <br /> GROUTING or DESTRUCTION Total Depth: tt. <br /> Depth to Water: <br /> Grout Material: J✓6t MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation C'Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> d�LA Type/Brand of Bentonite: <br /> ❑Pressure Grout dOver Drill g /lam Filter Pack Type/Size: <br /> ❑ Gravity Tremiej ❑Other: <br /> Type of Method: <br /> a Water cement 941b <br /> alto allons Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags rBentonite <br /> entonite/Cement Mix 3%Mix 5%Mix <br /> 10 1 entonite or 47 Ib 1.41 2.47 <br /> 2.5 5 1 5 2.82 4.7 <br /> 5 10 2 10 20 2 er 94lb <br /> 25 3 15 30 3 <br /> 10 <br /> 10 20 4 1 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 1 40 1B 00 80 B 10/16/2017 <br /> n t'd /f <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 1 www.sicehd.com <br />