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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: D I W Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: \c>170 MVS�N 5T_ Total Depth: <br /> WP# Well#: \0 Drilling Rig Type: <br /> Soil oring#: \^ \O <br /> Soil <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company:p 1rrQ-PcZAN � S�nL���� Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 4A\3O Oz- Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes rANo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes �1No casing <br /> If yes, location and distance: II\\ height <br /> ♦77 <br /> SAMPLING ABOVE-dRCMD <br /> Holding Temperature: CowpLuION CCoMPLEriON <br /> Method: Qiound mac' <br /> Screening Method: graA <br /> Verified Chain of Custody: ❑ Yes ❑No n' <br /> tf. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No ` <br /> If yes,spoils storage Location: won" <br /> sac�on <br /> Covered: ❑ Yes El No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: '.4 <br /> Depth to Water: 2 `J kit , n- n- <br /> Grout Material: N ! i (t�,�,�,y) MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <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 �Tremie OBJ ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> goa Ilons Bags gall ons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest ttBags 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />