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SAN JOAQUIN Environmental Health Department <br /> ",ram i —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: '� ('_"0 L(--)nspector: I 'n ' CONSTRUCTION <br /> Facility ddress: <br /> Well Address: �,- �2 C� Total Depth: <br /> WP# Q Well#: j (-)t+ ,. rlllingRigType: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: _ Bentonite From: To: <br /> Geologist: <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 /> height <br /> If yes, location and distance: <br /> SAMPLING A80vrm-dROUND G>1AIM43OX <br /> COWPLETION compt Enc;N <br /> Holding Temperature: Gmnd Sutao* <br /> Method: <br /> Screening Method: Oran <br /> Verified Chain of Custody: ❑ Yes El No tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No >:•If yes, spoils storage Location: Mottod � -= <br /> sacyon " = <br /> Covered: ❑ Yes El No :" = gravelpack <br /> If yes, material: <br /> jr <br /> GROUTING or DESTRUCTION Total Depth: ' ' = '' <br /> Depth to Water: <br /> z n. n. <br /> Grout Material: Gt' MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation CNell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: _ _— <br /> ❑Pressure Grout Dover Drill Filter Pack Type/Size: <br /> ❑ Gravity Kremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> algwsBags allons Ba s <br /> Thickest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5% MIX <br /> 2.5 i 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 3 15 30 3 <br /> 10 4 20 40 4 <br /> 12.5 5 25 50 5 <br /> 15 6 30 60 6 <br /> 17.5 7 35 70 720 8" 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 IF 209 464-0138 1 www.sicehd.com <br />