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$ANoJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> , , Grenlness grows Lr.re. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ,0 Z 2 Inspector: tnGf CONSTRUCTION <br /> Facility Address: A. <br /> Well Address: Total Depth: <br /> WP#f 'LR Well#: ` 51/�Drilling Rig Type: <br /> SoilN: <br /> Drillinging Company: 9t IA) Min 2" Annular EHD Seal Verified: ❑ Yes ONO <br /> Screen Length From: To: <br /> Driller Onsite: �h (r�QiLN <br /> Consultant: Ct)rAt)r Filter Pack From: To: <br /> Geologist: Loge , Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: � height <br /> —CWT <br /> SAMPLING ABOVE-GROUND crmlM43OX <br /> Holding Temperature: cohpLErION C,48COMPLETION <br /> Method: Grounds t"' —+•— <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n <br /> n. <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes ❑No " <br /> If yes, spoils storage Location: <br /> slotted <br /> Covered: ElYes ONO 44cdon Y; <br /> If yes, material: u - G-91 Pact <br /> GROUTING or DESTRUCTION Total Depth:,_ <br /> Depth to Water: & <br /> Grout Material: N ea- nL <br /> Gallons of Grout Used: ^-4.50 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags of Cement: <br /> METHOD USED /,t I b C Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill ✓ J <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water ement 471b Water Cement 94lb <br /> allons Ba a eallons Ba s <br /> Thickest Thinnest It W, Thickest I Thinnest nBags Bentonite#Cement Mix 8% MIX 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 z Bentonite er 94lb 2.82 4.7 <br /> 7.5 15 3 1s 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 15 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. Hazeiton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />