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SAN ;JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: 152 k,.bnA ( <br /> Well Address: Sb.\ArC. -Ly Total Depth: <br /> WP# O O V10 ,'Z <br /> kz - Well#: y Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: (�►�pOQ�(��W S�U•S(� A`�4 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: I?an�c�_�^ ��SJQ� Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist:�l�yQ�1`� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes )(No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes o <br /> 'RN\ casing <br /> If yes, location and distance: W- T <br /> height <br /> SAMPLING <br /> ABOVE-GROUND � <br /> Holding Temperature: COWFLET1AN cCOMr-a-rio N <br /> Method: cx«,n<t S`�rx <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑ Yes ❑No •�---~n <br /> tt. <br /> n. <br /> SPOILS — <br /> Contamination Noted: ❑ Yes ❑No <br /> h <br /> stated <br /> C <br /> If yes,spoils storage Location: stad ' <br /> s�cfon <br /> Covered: ❑ Yes ❑No 711 Pack <br /> Y = <br /> If yes, material: ' — <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tJ (Q - �- <br /> Grout Material: M"K <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <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 /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> *Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas izall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Gement 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 /> 2D 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 463-3420 1 F 209 464-0138 1 www.sicehd.com <br />