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( Environmerr Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Inspector: if ik114 CONSTRUCTION <br />ON° <br />IDNo <br />Public Water System Onsite: 0 Yes <br />Domestic Well Onsite: 0 Yes <br />If yes, location and distance: <br />0 Yes 0No Verified Chain of Custody: <br />SPOILS <br />Covered: <br />If yes, material: <br />0 Yes 0 No <br />bring Destruction LI Boring Installation <br />METHOD USED <br />r]Pressure Grout 0Over Drill <br />1,1<nie El Other: LI Gravity <br />Driller Onsite: <br />Consultant: <br />Geologist: LaAlica...4,. <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Contamination Noted: 0 Yes 0 No <br />If yes, spoils storage Location: <br />GROUTING or DESTRUiTION Total DepthZ?i <br /> , LA' <br />I <br /> 7_51 <br />I Depth to Water: <br />ri 4-eck <br />Gallons <br />- <br />Gallons of Grout Used: jo <br />/ / <br />/6 / 4, <br />, / 0 Well Installation 0Well. Destruction <br />Grout Material: <br />water <br />gallons <br />cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest # Bags <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <br />7.5 15 3 15 30 3 <br />10 20 4 20 40 4 <br />12.5 25 s 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 /2 017 <br />1868 E. Hazelton Avenue j Stockton, California 95205 T 209 468-3420J F 209 464-0138 www.sicehd.com <br />BentoniteiCement Mix 3% Mix <br />Bentonite per 47 lb <br />Bentonite per 94 lb <br />1.41 2.47 <br />2.82 4.7 <br />5% Mix <br />Sz•—e <br />WP# Well#: <br />Soil Boring#:0,-/Iit4 OtA <br />Drilling Company: 6.4/111A.A-C.44 -4 <br />Bentonite From: <br />Grout From: <br />COMPLETION 0 Stove Pipe <br />SAN ,JOAQUIN - <br />COUNT Y— <br />Grec, to vss gruly..! here. <br />Date: <br />Facility dres <br />Well Address: Total Depth: <br />Drilling Rig Type: <br />cq.1-11 <br />Min 2" Annular EHD Seal Verified: <br />Screen Length From: <br />Filter Pack From: <br />Yes El N o <br />To: <br />To: <br />To: <br />To: <br />OChristie Box <br />casing <br />height <br />AVE-6 ROUND <br />coi•ADLE-nohl <br />ft <br />siorta-d <br />a-avian <br />ft. <br />C.4-1191.51"?-p0X <br />COWIE-119M <br />Grourxi Surface <br />grout <br />ft <br />It <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: