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SAN:-J OAQ U I N Environmental Health Department <br /> . —COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �2 Ins�ector: CONSTRUCTION <br /> Facility Address: jab F,rN)nfc t 4 <br /> Well Address: Total Depth: <br /> W P# U() �9 0 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: I }'rCt `Vii.. Min 2"Annular EHD Seal Verified: El ❑No <br /> Driller Onsite: j 8SZ Screen Length From: To: <br /> Consultant: f/rvt(,T.�� <br /> Filter Pack From: To: <br /> A 1,ts.f /.P. <br /> Bentonite From: To: <br /> Geologist: ECI <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND C4iR_ <br /> Holding Temperature: COWLETION COMPLEnoN <br /> Method: Ground Sudaon <br /> Screening Method: 01 grout <br /> Verified Chain of Custody: ❑ Yes 11 No �ft' <br /> ft. <br /> ft. <br /> SPOILS <br /> w= � <br /> e <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: atottQe = E <br /> on <br /> Covered: ❑ Yes El No = g-ve, <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: >Ft,15 ��SFt ;4` <br /> Depth to Water:— <br /> PL5 17- ft. 21 <br /> n' <br /> Grout Material: NLat ctbu_ptll- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ipressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity '�6Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gall ons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest uBags 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 /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 11.5 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 /> c�(�C��•vLi ���'� -t-� I�ti� ( �-(� l� 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />