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SA JOAQUIN <br /> c Environmental Health Departmen <br /> —COUNTY— <br /> 1�cSu;-oa^''•, Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:li�25I1Q Inspector: K telex" CONSTRUCTION <br /> Facility Address:W. SC11U1te Pd. <br /> Well Address: Total Depth: <br /> WP# 004132(o l Well#: Drilling Rig Type: 9 <br /> Soil Boring#: blDI 0-+(o Ft 94 8 Min 2"Annular EHD Seal Ve$)fied: ❑Yes ❑No <br /> Drilling Company: Cure X cwy"BDA <br /> Driller Onsite: Cey- Screen Length From: To: <br /> Consultant: K1�dA-r Filter Pack From: To: <br /> Geologist: A\,Ao Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING yn � <br /> coi�riclta ctsrY-eox <br /> Holding Temperature: <br /> Method: ccir�asu�rxs <br /> Screening Method: 2rrcLa <br /> Verified Chain of Custody: ❑Yes ❑No 4 <br /> r�. <br /> SPOILS " _ <br /> Contamination Noted: ❑ Yes ❑No <br /> m <br /> If yes,spoils storage Location: <br /> Covered: ElYes ❑No r <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 50 -` <br /> p M"_ <br /> Depth to Water: , J'kwl A= A' it. <br /> Grout Material: WMN CetY► <br /> Gallons of Grout Used: Va.. <br /> 0?) Qat MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation L Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bags gallons Bags <br /> Thickest Thinnest ltBags W8O8 <br /> t 4Bags SentoniteXement MixJ!M <br /> 2.5 5 i 1 Bentonite per 47 Ib 5 10 2 2 Bentonite per 94 lb <br /> 7.5 15 3 3 t <br /> 10 20 4 4 <br /> 12.5 25 5 5 <br /> is 30 6 5 <br /> 17.5 35 7 7 <br /> 20 40 8 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue J Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />