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SAN. JOAQUIN <br /> Environmental Health Department <br /> COUNTY— <br /> �'cqr Grentness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 Inspector: CONSTRUCTION <br /> Facility Address: G(" L V`-& <br /> Well Address: Total Depth: <br /> WP# _3 _Well#: Drilling Rig Type: <br /> Soil Boring#:� 2 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: S to y) Screen Length From: To: <br /> Consultant: yy\-,' Filter Pack From: To: <br /> Geologist: j 0 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> —ev, <br /> SAMPLINGABOVE-GROUND CHRLSTY_ <br /> Holding Temperature: COMPLETION CCCWLEnON <br /> Method: Ground Surfocs If <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: sbn2e <br /> sac:on a — <br /> Covered: ❑ Yes ❑No <br /> If yes, material: U�� <br /> GROUTING or DESTRUCTION Total Depth:Depth to Water: • <br /> Grout Material: N a4-vim LN1I- 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 of 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 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest 9Bags Bentonite/Gement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 Bentonite per 94 Ib 2.82 4.7- <br /> 7.5 15 3 15 30 1 <br /> 10 20 4 20 40 4 <br /> 12.525 5 25 50 5 <br /> 15 0 6 30 60 6 I �t'aV ru w t V <br /> 17.5 35 7 35 70 7 <br /> aCl l/ <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />