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SAN J OAQ U I N Environmental Health Departmem'. <br /> —COUNTY - <br /> Greoines.c f)(, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: „I , I Inspector: I /13-0 CONSTRUCTION <br /> Facility Address: _Q 1'Giw it Ib <br /> Well Address: 't)-QCvy Total Depth: <br /> WP# 00-3 8 9 6q Well#: Drilling Rig Type: <br /> Soil Boring#:816,81� , '9 0113 1 I <br /> 8�( � Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: Mf <br /> ��-tom Screen Length From: To: <br /> Driller Onsite: o <br /> 'Ti' <br /> Consultant: rac Filter Pack From: To: <br /> Geologist: 4�r ' dm 1<� . <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 0 N COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: El Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING 118QYE-GROUND <br /> Holding Temperature: cot �rt°N cans--ncN <br /> Method: G=nd Surfaos <br /> Screening Method: pr�� <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. ft. <br /> SPOILS =_ <br /> a <br /> Contamination Noted: ❑ Yes 11 No <br /> If yes,spoils storage Location: = c <br /> 0 <br /> Covered: ❑ Yes ❑No = > <br /> If yes, material: <br /> GROUTING or DESTRUCTION T tal Depth:`0� 180rc <br /> Depth to Water: 10 g -----` "— '— tt- <br /> Grout Material: VC4101.4 Q M911.1f <br /> Gallons of Grout Used: =� �;4/10-k S MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation i IBSlot Size: <br /> oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ®Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas Raill ons Baps <br /> Thickest Thinnest kBags Thickest Thinnest ^Bags 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 z 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 r <br /> 20 A 20 40 4 <br /> 1205 25 5 25 5o 5 90 144,0 a-. <br /> 15 30 6 30 60 6 1 { 0 <br /> 17.5 35 7 35 70 7 ` la to,,? SLC 4 (Ei I 6g,",,,�z 1 <br /> 20 40 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />