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` SAN jOAQUIN <br /> Environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> Q Q Monitorin�g('Well/Soil Boring Inspection Report <br /> Date: ��/ I / Inspector: ITS l a L0- CONSTRUCTION <br /> Facility Address: 14 22 to 1.oy U- <br /> Well Address: I Total Depth: <br /> WP# c)()2,qWell#: _ Drilling Rig Type: <br /> Soil Boring#: P I I P 2 ( er( fieS+:5 Min 2"Annular EHD Seal Verified: ❑ Yes 11 No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 0 r h q rte( '4S5064!jts Filter Pack From: To: <br /> Geologist: '-Zc,L s-i - J Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: � height <br /> Iff— <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPIE ION CCOOMP�LEnoN <br /> Method: Ground Surface <br /> Screening Method: or«n <br /> Verified Chain of Custody: ❑ Yes ❑No �--n' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: Slott" <br /> a.cdon = <br /> Covered: ❑ Yes ❑No = gr.,,,I t <br /> ak <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: ?J t� S t� ''• <br /> Depth to Water: (10 a-U <br /> Grout Material: <br /> Gallons of Grout Used: 6 Qo­1 MATERIALS/DEVELOPMENT <br /> j Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation gBoring Destruction gags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> X Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bag gall ons Bags <br /> Thickest Thinnest Jt Bags Thickest Thinnest #Bags 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 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 11 , � !'5 bas 10/16/2017 <br /> �1 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />