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SAN J OAQ U IN Environmental Health Department <br /> " I. <br /> —COUNTY— <br /> Greatness grows here. <br /> Mon��itnno''ring Well/Soil Boring Inspection Report <br /> Date: �') Inspector: Vv� CONSTRUCTION <br /> Facility Address: 5-5 0 2ao CL - <br /> / <br /> ri <br /> Well Address: Total Depth: 2V to `> � � � �•� 442AIA <br /> WP# 6 V Well#: / Drilling Rig Type: l <br /> Soil Boring#: a 1 C ' Z ISS 9 3 Cs t <br /> Drilling Company: Z�� Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: � Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: �A�,E I& / ��_� 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: 17 <br /> height <br /> SAMPLING /ABOVE-GROUND <br /> Holding Temperature: CONFLE ION COMPLETION <br /> Method: Ground Surf acs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> slotted <br /> a�c�on <br /> Covered: ❑ Yes ❑No <br /> gravvi pack <br /> If yes, material: SSM ' <br /> GROUTING or DESTRUCTION Total2 Depth: bC 15 <br /> Depth to Water: rU io ' 6-5,,, e3 C5n- <br /> Grout Material: � � C-5'') <br /> Gallons of Grout Use 0 - MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction �� � Blank Feet Screen Feet <br /> ❑Boring InstallationABoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pre sure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ,Gravvi yg� YTreg1 '�1 ❑Other: Type of Method: <br /> Water Ceme b water Cement 94 lb <br /> allons Bas vallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest .1 Bags Bentonite/Gement Mix 3% Mix 5% Mix <br /> 2.5 s 1 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 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 /> 1 30 30 7 7 0 V <br /> 17.. 7 70 <br /> 35 7 <br /> 5 35 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> ���J <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />