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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> y Monitoring Well/Soil Boring Inspection Report <br /> 2j�Date: I Inspector: r W/ aCONSTRUCTION <br /> Facility Addres >0"1 S . <br /> Well Address: y Total Depth:� S n L' ,+ � <br /> W P# 0D3g 12 W//JJell#: Drilling Rig Type:::19 <br /> Soil Boring#: & I ,�Z. R 3, BN YDS, �� j f Z Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company:'KL,L, &_rx f <br /> Driller Onsite: "Tv Screen Length From: To: <br /> Consultant: r6l�4L" c,'a Filter Pack From: To: <br /> Bentonite From: To: <br /> Geologist: �' <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 1:1 No casing <br /> If yes, location and distance: 37 <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: 0O16VLEflON COOMPPtEnoN <br /> Method: Ground Sumacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —`---n' <br /> n. <br /> n. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No =` <br /> If yes, spoils storage Location: atonal <br /> sscd '' <br /> an — 3 <br /> Covered: ❑ Yes El No (O+ ' ' =_ t-wv+t� <br /> If yes, material: g <br /> I ' <br /> GROUTING or DESTRUCTION Total Depth: 16 P 6 3 60� _. =_ <br /> IF <br /> Depth to Water: 14 FA M 10 , n• n' <br /> Grout Material: AA2 <br /> Gallons of Grout Used: Q q0-1 l3� I C). MATERIALS/DEVELOPMENT <br /> 11 Tl 3 I Casing Type: <br /> ❑Well Installation ❑Well Destruction TZ' o Blank Feet Screen Feet <br /> ❑Boring Installation 1913Slot Size: <br /> oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill ^' <br /> f�ST r Filter Pack Type/Size: <br /> ❑ Gravity gTreemie 50ther: Ey -�( Type of Method: <br /> Water Cemen 471b Water Cement 941b <br /> allons Ba 5REall ons Bags <br /> Thickest Thinnest XBags Thickest Thinnest trBags 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 /> 12 q�� ( 10/16/2017 <br /> 1868 E. (Hazelton Avenue Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />