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u11 ' <br /> 06 SAN ,JOAQUIN <br /> Environmental Health Department <br /> N' ` <br /> I �. COUNTY— <br /> \ct1Pi Greatness grows here. <br /> � y' <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 12 is �� Inspector: f t- CONSTRUCTION <br /> Facility Address: 1305 G ZSC1A Q M <br /> Well Address: Total Depth: <br /> WP# DDSMOLA Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: I -rA.C.b VEL <br /> Driller Onsite: jt�S-� �1�.� Screen Length From: To: <br /> Consultant: Be r0 Filter Pack From: To: <br /> Geologist: / 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 /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION c mPLEnoN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No ir —n. <br /> n. <br /> n. <br /> SPOILS <br /> e <br /> Contamination Noted: ❑ Yes ❑No <br /> C <br /> If yes,spoils storage Location: <br /> sacdonM <br /> Covered: ❑ Yes ❑No g-,vi pack <br /> If yes, material: [ /� <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: V'S n• IF n. <br /> Grout Material: Iy LAIR C <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <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 14+remie ❑Other: Type of Method: <br /> Water 116,enl 471b Water Cement 941b <br /> allons k Bas gallons Bags <br /> Thickest Thinnest gs Thickest Thinnest #Bags Bentonite/Cement Mix 3% 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 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> Q\0� �� g� wu �5 Ppe1 -� ISo� r�ct ' + "(LI711010/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />