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SAN JOAQUIN Environmental Health Department <br /> -COUNTY <br /> Greatness grows here. <br /> � <br /> f��iQ Monitoring Well/Soil Boring Inspection Report <br /> Date: t o G"/ `/ Ins ector: !'a- CONSTRUCTION <br /> Facility Address: e y 1 <br /> 1 pm"4 <br /> Well Address: Total Depth: <br /> W P# 0 n�j Z Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Comp Go' �, Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND __ <br /> Holding Temperature: CO�"��ION �PtEnoN <br /> Method: Ground Surtaios <br /> Screening Method: ZZ11 ori <br /> Verified Chain of Custody: ❑ Yes ❑No 1 n' <br /> tt. <br /> it. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted = 3 <br /> s.cdon <br /> Covered: ❑ Yes ❑No g, <br /> viW pack <br /> If yes, material: _— <br /> GROUTING or DESTRUCTIONotal Depth: f '• __ <br /> Depth to Water: I Y F1tt. <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation15Boring Destruction Slot Size: <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 /> ❑ Gravity Tremie ❑Other: Type of Method: <br /> Water Cemen 471 Water Cement 94 lb <br /> allons Bag gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 7t Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.821 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 /> 0 40 8 40 80 8 <br /> Ickton, <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I California 95205 1 T 209 468-3420 1 F 209464-0138 www.sicehd.com <br />