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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: <br /> Addr �� Inspector: 'T CONSTRUCTION <br /> Facility10 S. 91 lob <br /> Well Address: Total Depth: <br /> WP# Z&D jakj Well#: MW- Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: ,S Filter Pack From: To: <br /> Geologist: 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: tOrPLETbN �tnoN <br /> Method: Ground Swacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: atottoa <br /> = B <br /> sacaon — <br /> Covered: ❑ Yes ❑No _ ate* <br /> If yes, material: �J <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tS" ft. <br /> Grout <br /> Grout Material: P,4f, G41'Y1 °I� � n�� <br /> Gallons of Grout Used: � /�q 11 D11�,I MATERIALS/DEVELOPMENT <br /> J Casing Type: <br /> ❑Well Installation 6kmell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑B Slot Size: <br /> oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED �QJY� Bags Sand/Gravel: <br /> ��U Type/Brand of Bentonite: <br /> L 0'.El Grout NOver Drill Filter Pack Type/Size: <br /> ❑ Gravity Y.Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags pallons Bags <br /> Thickest Thinnest ltBags Thickest Thinnest uBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 ,N/J�l(J1►J( 4 ( �,fJ�/�.I� '/ <br /> 12.5 25 5 25 50 5 ` \ a/1/" , V r �J"V <br /> 15 30 6 30 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 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />