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SAN JOAQUIN Environmental Health Department <br /> --COUNTY- -- <br /> �;;.irr:ne>s qrr <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: 0j1"sQ­ CONSTRUCTION <br /> Facility Address: 9'oq 'j• , (-gtrf " <br /> Well Address: Total Depth: <br /> WP# 0 01D 6 l 3 Well#: Drilling Rig Type: <br /> Soil Boring#: [ <br /> Drilling Company: tr,I h C ' Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: AV141 Screen Length From: To: <br /> Consultant: 0k,Fed¢r Filter Pack From: To: <br /> Geologist: Fy L Bentonite From: 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-GIRCUND <br /> Holding Temperature: a�``'�— iOC� corks=,7CN <br /> Method: Ground Stxfacs <br /> Screening Method: gr«t <br /> Verified Chain of Custody: ❑ Yes ❑No —` ft <br /> ft. <br /> ft. <br /> SPOILS — <br /> Contamination Noted: ❑ Yes ❑No _— <br /> If yes, spoils storage Location: <br /> aIcttvd = <br /> sarcn — � <br /> Covered: ❑ Yes El No <br /> If yes, material: <br /> r = <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ft• — ft <br /> Grout Material: orAlwa C.p�r MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:. / 1[sb Casing Type: <br /> e: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ljqSlot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> �4&avity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47 11) Water Cement 9411) <br /> allons Bas oallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% MIX 5% Mix <br /> 2.5 5 1 5 l0 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 /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 <br /> 20 40 8 40 80 8 <br /> 4D 30,1 « ba 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 />