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• SAN JOAQUIN Environmental Health Department <br /> COUNTY- <br /> Greatness grows her. <br /> Q Monitoring Well/Soil Boring Inspection Report <br /> Date: O ,Z Inspector:D44-4 OO '' CONSTRUCTION <br /> Facility Address: 1 34 5 /�/ EX—te�S%OY1 F-c� <br /> Well Address: Total Depth: t i <br /> WP# 00 3302 Well#: Drilling Rig Type:--R— <br /> Soil <br /> -Soil Boring#: S 91 1s 13 Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: e A-[ a v1 <br /> Driller Onsite: 0 r'�" <br /> Screen Length From: To: <br /> Consultant: 0— Filter Pack From: To: <br /> Geologist: C r�s--�ap�,t.�-- Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes F1 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: 0OWLE7toN COMP=CN <br /> Method: Ground Surlatics <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No .eft. <br /> M. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes L1 No <br /> If yes, spoils storage Location: QS�QO �S lx q <br /> t�clon <br /> Covered: El Yes El No �j13 . �S f = g-vdam <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 0�5 f "' - IF <br /> Depth to Water: K�P' n - n' <br /> Grout Material: " MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: a 10 UCA <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> /n <br /> � i Filter Pack Type/Size: <br /> ravity ®.TreIII? <br /> ie ❑Other: Type of Method: <br /> Water Cemen 4711 water Cement 941b <br /> allons Bas allons Bags <br /> Thickest Thinnest 4Bags 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 /> 2c 0 9°d LI 1 b twi S 10/16/2017 <br /> 1868 E. Hazelton Avenue I Tlkton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />