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SAN JOAQUIN <br /> Environmental Health Department <br /> —COU NTY-- <br /> cqr Greatness grows here. <br /> L� Q Monitoring Well,/Soil Boring Inspection Report <br /> Date: 1 / Inspector: PY144�- CONSTRUCTION <br /> Facility Address: ✓-O,-a <br /> Well Address: Total Depth: <br /> WP# oo 0 Well#: Drilling Rig Type: <br /> Soil Boring#: C I <br /> Drilling Company: C�c� 7\ ;7 Min 2"Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant:_ Filter Pack From: To: <br /> Geologist: - h �— Bentonite From: To: <br /> Z <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 1:1 No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND CHR_ <br /> Holding Temperature: COMPLETION comPLEncN <br /> Method: around Surlace <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> M <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: atoned <br /> n <br /> Covered: ElYes ❑No aeo <br /> — grave pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: IF <br /> • <br /> Depth to Water: % 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 /> El Boring Installation NBoring 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 [�;Tremie ❑Other: Type of Method: <br /> Water Cemen 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest ABags 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 1 30 6 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 1 40 8 40 80 8 <br /> I O qo,I \ 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />