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°u'" SAN JOA UIN <br /> ° o Q <br /> a p` <br /> `2 Environmental Health Department <br /> 1" <br /> COU NTY-- <br /> °qcPGreatness grows here. <br /> Monitoring /Well//,Soil Boring Inspection Report <br /> Date:9 Inspector: 4�44�_ CONSTRUCTION <br /> Facility Address: <br /> Well Address- Total Depth: 1 <br /> WP# 0 0 Well#: Drilling Rig Type: <br /> e-f� <br /> Soil Boring#: <br /> Drilling Company: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: <br /> Screen Length From: To: <br /> I�i�� Filter Pack From: To: <br /> Consultant: c Lt_.Irh <br /> Geologist: I. � <br /> 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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWP�noN OmPLEnoN <br /> Method: Gro"Surfaos <br /> Screening Method: Oran <br /> Verified Chain of Custody: ❑ Yes 1:1 No <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El NoJE <br /> If yes, spoils storage Location: abnsa ,_ <br /> soclon — <br /> Covered: ❑ Yes ❑No <br /> cnw+Pack <br /> If yes, material: r <br /> GROUTING or DESTRUCTION Total Depth: S0 1 • =_ <br /> Depth to Water: �__j f y n' <br /> Grout Material: /VP,A <br /> Gallons of Grout Used: 3 <br /> MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation CgBoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity UTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest #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 /> I qa I bav 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />