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SAN JOAQUIN Environmental Health Department <br /> " COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> ,fI `'"' <br /> Date: 111111,V Inspector: CONSTRUCTION _ <br /> Facility Address: SZe At'le- !2 3� �4 S <br /> Well Address: Total Depth: <br /> WP# tx,)3 W7.& Well#: Drilling Rig Type: <br /> Soil Boring#: � 2, 3 !/ „ <br /> Drilling Company: �/�, W Min 2 Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: iQ Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: lyeiy,ej.3So 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: WT <br /> height <br /> SAMPLING AsovE.GROUND CHRISTY_ <br /> Holding Temperature: COWLEMN C> LEncN <br /> Method: Ground Surf=* T <br /> Screening Method: aroLA <br /> Verified Chain of Custody: ❑ Yes El No —` n' <br /> t <br /> —ft. t. <br /> SPOILS <br /> v1 - O <br /> Contamination Noted: ❑ Yes ❑No =' <br /> If yes, spoils storage Location: stoned <br /> .on — B <br /> Covered: ❑ Yes []No <br /> = v <br /> ack <br /> If yes, material: x <br /> GROUTING or DESTRUCTION Total Depth: — <br /> Depth to Water: Z.O <br /> Grout Material /Wt? MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation WBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Pressure Grout []Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity DVremie ❑Other: Type of Method: <br /> ater Cement 471b Water Cement 941b <br /> all Bas gall ons Bags <br /> Thickest Thinnest uBags Thickest Thinnest tlBags 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 /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 1 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 80 8 <br /> q1 2 10/16/2017 <br /> 1868 E. Hazelton Av nue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />