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l <br /> SAN, JOAOUIN Environmental Health Department <br /> COUNTY— <br /> Greatness grows here, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I-t3-z Inspector: k&. CONSTRUCTION <br /> Facility Address: MO 5 Iti Q S <br /> Well Address: Total Depth: <br /> WP# 2 oo 1-Z l Well#: Drilling Rig Type: <br /> Soil Boring#: Sg—t t <br /> / Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: C QXacrG <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: aS Filter Pack From: To: <br /> Geologist: S�/dw 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 El No casing <br /> If yes, location and distance: f� natynt: <br /> SAMPLING AeovEECaaoUND <br /> COMPLETION COMPLETIO <br /> Holding Temperature: COMPLETION <br /> Method: GroundSuiaa <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No 1 n' <br /> n. <br /> ^n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> �E my <br /> If yes,spoils storage Location: started <br /> Covered: ❑ Yes ❑No &arJon Ei <br /> = $ <br /> may; g-,r l pack <br /> If yes, material: i = :. <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: /v1 Geu <br /> Gallons of Grout Used: 17 oalte"s MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Boring Destruction Slot Size: <br /> 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 K I remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement941b <br /> atlons Bags allons Ba s <br /> Thickest Thinnest NBags Thickest Thinnest 4Bags Bentonite/Cement MIX 3%MIX 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 1 2.821 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 B 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 />