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SAN:JOAQUIN Environmental Health Department <br /> COUNTY <br /> - <br /> Gieatness grows here. <br /> / / Q Monitoring Well/Soil Boring Inspection Report <br /> Date: 1/ IS/ �1 Sinspector: fIa O^ lYl�� CONSTRUCTION <br /> Facility Add ress:a6� N (,Cti'P�'�SAc►'P C•�`W ► (,tIt <br /> Well Address: Total Depth: <br /> WP#L]0391 66 W II#: Drilling Rig Type: <br /> Soil Boring#: y I� ! Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: Teyr�l C-C N <br /> Driller Onsite: I—Less'-_ Screen Length From: To: <br /> Consultant: con Filter Pack From: To: <br /> Geologist: c, p— 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: ITTLT height <br /> SAMPLING ASOVE-GROUND <br /> Holding Temperature: 0016P�1ON ccomP�iE-noN <br /> Method: G=nd Suiares <br /> Screening Method: grotA <br /> Verified Chain of Custody: ❑ Yes ❑No n' <br /> tt. <br /> —ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No =` <br /> If yes,spoils storage Location: abed <br /> sac�on '— <br /> Covered: ❑ Yes ❑No = tw+p..k <br /> If yes, material: // _ <br /> GROUTING or DESTRUCTION Total Depth: o � X6 IF tZ. __ <br /> Depth to Water: 0 IN A n- 1 1 F n <br /> Grout Material: ffTA <br /> Gallons of Grout Used: 102 4 at icAS MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Sorin Installation Slot Size: <br /> g goring 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 /> tZ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest aBags Thickest Thinnest 1t Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 s 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 la 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />