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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: &vya- CONSTRUCTION <br /> Facility Address: E/Ia. 5-f <br /> Well Address: Total Depth: <br /> WP# 5' Well#: Drilling Rig Type: /3s R S A Ce" <br /> Soil Boring#: S <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> j <br /> Driller Onsite: A oat/ Screen Length From: To: <br /> Consultant: vt Ge �,,� <br /> Filter Pack From: To: <br /> Geologist: {'VteIL, 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 /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: C0NFLETION CCOMPPLEn.ON <br /> Method: Ground Sudwo <br /> Screening Method: <br /> Verified Chain of Custody: ❑ Yes ❑No n• <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> slotted ' <br /> atwrlon Y = B <br /> Covered: El Yes El No <br /> �' <br /> grate pack <br /> If yes, material: _= <br /> GROUTING or DESTRUCTION Total Depth:20 5o <br /> Depth to Water:n0 vllk3 S n• " — n• <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation XBoring 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 /> 9 65 <br /> '59-Gravity 5� remie ❑ Type ype of Method: <br /> Water Cemen 471b Water Cement 941b <br /> allons Ba allons Bags <br /> Thickest Thinnest ttBags 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 /> JIV94 q0 6 /� 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 />