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SAN JOAQUIN <br /> Environmen_ . Health Department <br /> —COUNTY <br /> Greatness gro;,s -r-. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:1 w if Inspector: L.- CONSTRUCTION <br /> Facility Address: `tsl I1'' 51 Trac.-a <br /> Well Address: Total Depth: <br /> WP# 0-0 7VIVIO Well#: Drilling Rig Type: <br /> Soil Boring#: C7 Li'L- , (iv 3) [r...r q <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: &n4SA t)w1M Screen Length From: To: <br /> Driller Onsite: Low <br /> Consultant: Ttirrw.�hl:�R- 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 /> iii <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: cowLE'rION COMPt�ON <br /> Method: GroundSurtan + <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑ Yes ❑Non' <br /> tt. <br /> fi. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: stoned c: <br /> sac:on x <br /> Covered: ❑ Yes ❑No <br /> = 9r"'°t Park <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: - _ <br /> Depth to Water: LS-Q11 <br /> Grout Material: 0t&4 Cew.,--N- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 1& <br /> -OV -- j Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation IL14oring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> � Filter Pack Type/Size: <br /> PGravity Pfremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 4Bags 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 /> 2 1 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />