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ou" SAN JOAQUIN <br /> �:. Environmental Health Department <br /> ` — <br /> COUNTY-- <br /> Gr eotness <br /> OUNTY -Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> d `` k <br /> Date: `� I I Inspector:1, O'f � �J • CONSTRUCTION <br /> Facility A dress: 6 5 . Ov <br /> Well Address: Total Depth: n <br /> WP# 00 a �J Well#: Drilling Rig Type: k1514 I <br /> Soil Boring#: — Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: kf k W Dril-linj <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: ,� Filter Pack From: To: <br /> Geologist: 0� a Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION COMPLEnoN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: �1 I slotted <br /> 'L sKJon pa <br /> Covered: ❑ Yes El No IJ _ <br /> grrw+pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_ 4• -_ <br /> Depth to Water: n' it. <br /> Grout Material: <br /> Gallons of Grout Used: 130 ��4 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation []Well Destruction Blank Feet Screen Feet <br /> El Boring Installation'�Boring 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 Cement 47 b Water Cement 941b <br /> gall!ons Bas allons Bags <br /> Thickest Thinnest xBags Thickest Thinnest #Bags Bentonite/Cement 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 5o 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> g C 10'1 2 b cty f 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 />