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!�°UIN; <br /> ° - SAN JOAQUIN Environmental Health Department <br /> - ---COUNTY <br /> -91LP' Greatness grows here. <br /> I / Monitoring Well/Soil Boring Inspection Report <br /> Date: { Z� /Inspector: CONSTRUCTION <br /> Facility Address: 6 5 6, La cge 4 pe-j St, <br /> Well Address: Total Depth: ��JJ <br /> WP# DD Q 3 Well#: Drilling Rig Type: s4 <br /> Soil Boring#: 6 I —6 Min 2"Annular EHD Seal Verified:` ❑ Yes ❑No <br /> Drilling Company: <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 ABOVE-GROUND <br /> Holding Temperature: CoW�nr <br /> oN carwLEnoxi <br /> Method: Ground Surfak* <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No >` <br /> If yes, spoils storage Location: abed <br /> sac�on x <br /> Covered: ❑ Yes ❑No g,,,*1 pack <br /> If yes, material: 4' <br /> GROUTING or DESTRUCTION Total Depth: 5 <br /> (;N/Y) _ . <br /> Depth to Water: _ n' <br /> Grout Material: kvA+ CeddI L " MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: `�� a <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation fgBoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> [7�Gravity ❑Tremie ❑Cit her: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3% 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 /> (J q g/Low l -5 I _Stol� 10/16/2017 <br /> (p 11868 E. Hazelton Avenue rStockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />