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SAN J OAQ U I N Environmental Health Department <br /> fes"" COUNTY <br /> Greatness grows her <br /> 91.IF00.%. <br /> Monitoring Well/Soil Boring Inspection Report 10 <br /> Date: Inspector: 1Vizt,-eP1►- CONSTRUCTION 7�04 <br /> Facility Address: (o5b1 18vCyt,,si- e P,4 i <br /> t �.S <br /> Well Address: Total Depth: �� <br /> WPW_nc') 3 }S� Well#: Drilling Rig Type: 7 264J he " 6�i_Dr"F. 4 <br /> Z'v 6b` 0��lz <br /> M <br /> Drilling Company: j tj <br /> Driller Onsite: jTcz.�k <br /> Soil Boring#: � Min 2 Annular EHD Seal Verified: El Yes ❑No 6• <br /> Screen Length From: To: <br /> � � <br /> Consultant: /h ;`F,•c. Filter Pack From: To: � S <br /> Geologist: 19e/w 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 ❑No WT <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION cCOMPt.EnccN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No = <br /> If yes,spoils storage Location: atoned <br /> section — B <br /> Covered: ❑ Yes ❑No <br /> If yes, material: =_ <br /> GROUTING or DESTRUCTION Total Depth: t —_ <br /> Depth to Water: 3 Y4. n• n <br /> Grout Material: Al !wt ee,,� <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation y413oring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Xressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> ir- stir ent 4 Ib water Cement 941b <br /> Bas gall ons Bags <br /> Thickest Thinnest it Bags Thickest Thinnest zBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.821 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 7 <br /> 20 40 8 40 80 8 <br /> �-Z_J �d 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />