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c <br /> SANJOAQUIN Environmental Health Department <br /> --COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: lqu / Inspector: CONSTRUCTION <br /> Facility Address: 8e-h.5�Ae,,-rL <br /> Well Address: Total Depth: <br /> WP#dAp 3%Q SD Well#: Drilling Rig Type: <br /> Soil Boring#:� 2.3. i/, -.(a <br /> Drilling Company: Er la.-aXA1_ so_.Me <br /> Min 2' Annular EHD Seal Verified: ❑ Yes []No <br /> Driller Onsite: 1 71e Screen Length From: To: <br /> Consultant: (!�10,7.e-* Sku..c Filter Pack From: To: <br /> Geologist: ,8-, �0' <br /> 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-GROUND CHMM_ <br /> Holding Temperature: COWPLETION COMPLEnoN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> ft. <br /> SPOILS B1 �• —' <br /> Contamination Noted: ❑ Yes ❑No 8 Zia, y�S & <br /> If yes, spoils storage Location: <br /> an — <br /> Covered: ❑ Yes ❑No _ __ gravol Pack <br /> If yes, material: _= <br /> GROUTING or DESTRUCTION Total Depth: _3!5i 4. <br /> Depth to Water: u n• n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation kBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> ater nt 471b Water Cement 94 lb <br /> Rallo B gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest ttBags Bentonite/Cement Mix 3°/a Mix 3% 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 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> 7 Zq 10/16/2017 <br /> 1868 E. Hazelton Avenue California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />