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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: U l �/ In�ector: c' o' 4 1 CONSTRUCTION renFacility Address: 6A <br /> Well <br /> tal Depth: <br /> WP#®0'2j Well#: Dor(lingRigType: 6I,gq 166 PSA; LJ /r 1 .PW14-- <br /> Soil Boring#: A — Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: bur ✓t 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 El No casing <br /> If yes, location and distance: height <br /> —CWT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWP.ETION CCMPLEnON <br /> Method: around S"'}"' <br /> Screening Method: or«n <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> n. <br /> tt. <br /> SPOILS - — <br /> Contamination Noted: ❑ Yes []No r' <br /> If yes, spoils storage Location: J sb = 8 <br /> 6;2(' <br /> 2' tO aacJonedn <br /> ❑ <br /> Covered: Yes El No n�L g-„W pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: �s Tl 6q: IS <br /> Depth to Water: 2— 6 6: '5F4 l: •S n- <br /> Grout Material: <br /> IL: 10 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: —4-0 Qo­l <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity -?STremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Saps <br /> Thickest Thinnest 7t Bags Thickest Thinnest 9Bags 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 /> rl 1 10/16/2017 <br /> 1868 E. zelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />