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SAN JOAQUIN Environmental Health Department <br /> COU NTY— <br /> `'�o"F_ Greatness grows here. <br /> M✓i 130119 <br /> zr'� Monitoring Well/Soil Boring Inspection Report <br /> Date; JV Inspector: l o,—e(, 4 CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: 3 Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: ( S Cx�Lo�o��br Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: "0 i Yt Filter Pack From: To: <br /> Geologist: o rr 2 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> iii <br /> SAMPLING ABOVE GROUND <br /> Holding Temperature: COWLETION CCOMPPLET]ION <br /> Method: G=nd Surface <br /> Screening Method: arart <br /> Verified Chain of Custody: ❑ Yes El No —`--n' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: Bien" <br /> "Cdon <br /> Covered: ❑ Yes ❑No i <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: so F . __ •. <br /> Depth to Water: �?_ F Itt- <br /> Grout Material: � C Ajk1 <br /> Gallons of Grout Used: 0 y _( MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Borin Installation Slot Size: <br /> g `Boring 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 /> ❑ Gravity ERTremie ❑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 /> lQ y° 10/16/2017 <br /> qs ' J 12 s <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />