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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greutness grows here. <br /> ` Monitoring Well/Soil Boring Inspection Report <br /> Date: 1 Inspector: Ww CONSTRUCTION <br /> Facility Address: <br /> Well Address: 01,40 f� . N0�{�M�C(Ui,,'� Total Depth: <br /> WP# �b`k —We ll#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: ��oj '0�(��, „ <br /> Driller Onsite: Q�\n�l Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: ' _`� y\1CO Q k Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: 11 Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 171 No casing <br /> If yes, location and distance: height <br /> WT <br /> SAMPLING Ai Vr=-GROiPubD <br /> Holding Temperature: COWL.E )ON cooMpoN <br /> Method: G=nd Sutacs <br /> Screening Method: gro«n <br /> Verified Chain of Custody: ❑ Yes 11 No ft. <br /> ft. <br /> ft. <br /> SPOILS — <br /> Contamination Noted: El Yes ❑No ;., _ _• o <br /> If yes,spoils storage Location: s�;Oxaa <br /> iR.IQA <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> N <br /> GROUTING or DESTRUCTION Total Depth:10 710 <br /> Depth to Water: NJL <br /> Grout Material: Nor <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 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 ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> ailons Bas lZall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.411 2.47 <br /> 5 10 z 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 1 70 7 <br /> 20 40 B 1 40 1 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />