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SAN J OAQ U I N Environmental Health Department <br /> —COUNTY— <br /> Grectness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: /4' �� Inspector: 44S'&10"1� CONSTRUCTION <br /> Facility Address:3ee &/✓4 <br /> Well Address: Total Depth: <br /> WP# CV31Xff Well#: Drilling Rig Type: <br /> Soil Boring#: e'RL/, 2_� 31 q Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: 1-'o- EX <br /> Driller Onsite: ,/yj�� Screen Length From: To: <br /> Consultant: ��"' <br /> Filter Pack From: To: <br /> Geologist: -Z k Ye Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: COMPLIEMON CoMP�LEMN <br /> Method: Ground SLwl=s <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> ft. <br /> SPOILSr <br /> Contamination Noted: ❑ Yes ❑No <br /> 30 <br /> If yes, spoils storage Location: slotted <br /> on <br /> Covered: El Yes El No <br /> C�f�> yap _ <br /> If yes, material: Z� g"wPack <br /> GROUTING or DESTRUCTION Total Depth:A0 <br /> Depth to Water: -Z,/' IF <br /> tt' <br /> Grout Material: Veale .0"e-y <br /> Gallons of Grout Used: I' �� / /Z y, /r j �y MATERIALS/DEVELOPMENT <br /> _J Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation kBoring 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 j4Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gall ons Bags <br /> Thickest Thinnest uBags Thickest Thinnest 9Bags 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 1 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 209 468-34201 F 209 464-0138 www.sicehd.com <br />