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SAN:�JOAQUIN p <br /> 2 Environmental Health Department <br /> COUNTY <br /> °qtP Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 6 / Inspector:'- /p- < CONSTRUCTION <br /> Facility Address: `0 {� �/, [n/i' Sah t4/L-V 05A <br /> Well Address: Total Depth: �I <br /> WP# O 3 S O Well#: Drilling Rig Type: ��2`� ��� N S� 6 �04W <br /> Soil Boring#: CKr <br /> Drilling Company: e-ILj!2c'� Min 2"Annular EHD Seal Verified: 11 Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: -(ir•`a(ovn Filter Pack From: To: <br /> Geologist: G✓i c, 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-GRpLMp <br /> Holding Temperature: COMPLETIONEnoN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No M <br /> tt. <br /> tt. <br /> SPOILS - <br /> Contamination Noted: ❑ Yes E]No <br /> If yes, spoils storage Location: atoned <br /> Covered: ❑ Yes ❑No <br /> t-wt park <br /> yes, material: <br /> �) S <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 4.1'� 3 n- — n- <br /> Grout Material: C <br /> Gallons of Grout Used: I SO ,t 04 <br /> MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring InstallationEXBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> El Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> � <br /> Gravity ST�efnie ❑Other: Type of Method: <br /> I <br /> Water Cemen 471b Water Cement 941b <br /> allons Bags eallons Bags <br /> Thickest Thinnest xBags Thickest Thinnest ttBags 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 /> L. 0 � bVq 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />