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SAN�JOAQUIN <br /> I•, � , . ;i Environmental Health Department <br /> _ <br /> COUNTY— <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: P(Ild Inspector: L.O:r- CONSTRUCTION <br /> Facility Address:gf04 C •-- <br /> Well Address: Total Depth: <br /> WP#aD;,pt" Well#: Drilling Rig Type: 6!_\� rfk-wr � <br /> Soil Boring#: <br /> DrillingCompany: (yrs ck; 1 l�r � Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> p Y� ��nvt��xs <br /> Driller Onsite: IC <br /> ��� J Screen Length From:_Zn_'5__P(_ To: 3 I54:Z> <br /> Consultant: Filter Pack From: To: 3Z.*_ { <br /> Geologist: Bentonite From: 0-01s- To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-6ROUi D <br /> Holding Temperature: 0016 r'LErION ccomPPLEnnooN <br /> Method: Ground Swfaca <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No f' <br /> tt. <br /> n. <br /> SPOILS = <br /> a <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes,spoils storage Location: slatted = ' <br /> Covered: ❑ Yes El No w <br /> — wZwVl Pack <br /> Ifyes, material: <br /> GROUTING or DESTRUCTION Total Depth: 0 It- <br /> Depth to Water: M <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> �� Casing Type: Ir ,"c-4, e vc <br /> SeWell Installation ❑Well Destruction Blank -7,ye Feet Screen 'to Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction gags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity N��remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gallans Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 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 /> 715 15 3 15 30 3 i <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 1 30 30 0 Z 5O <br /> 17.. 7 7 7 5 35 7 35 70 7 (/" <br /> 20 40 8 40 80 8 <br /> -' KC.w.�( d� V� -��c l.�rc� a P.r.ww� �rwl•�' 1 ca-�"^'� 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br /> '� Ti�ror1M drv��✓ 'L" Cj�CII.�� o�'� �n�'� '�-t"�Ch —�i�,`.'nd <br />