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SAN JOAQUIN Environmental Health Department <br /> iii it —CGUNTY— <br /> ' Greatness grows hent <br /> 7 /a Monitoring Well/Soil Boring Inspection Report <br /> Date: 3 2(o / ! Inspector: CONSTRUCTION <br /> Facility Address: S C, r -n Sw i _ 1,P4 <br /> Well Address: Total Depth: <br /> WP#_�_ Well#: Drilling Rig Type: <br /> Soil Boring#: ��� �Z Min 2" Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: _K , <br /> Driller Onsite: Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: ern.i�-tall h, Bentonite From: To: <br /> _ <br /> Lj <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes E-]No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GRCUND <br /> c �CHolding Temperature: =N4PLET10N x� N <br /> Method: Ground sur+ac. <br /> Screening Method: o'O11 <br /> Verified Chain of Custody: ❑ Yes 1:1 No rt' <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No # 20 _ <br /> If yes, spoils storage Location: y ft <br /> ,ice _ 3 <br /> 2TT <br /> 1 �fc cn <br /> Covered: ❑ Yes CI No(� f 5-ft ;,wl;:x <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 12- 5ofr <br /> Depth to Water: n. 2 tt. <br /> Grout Material: NJ C at CC Kyl-CyLT <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> - Casing Type: - <br /> ❑Well Installation ClWell Destruction Blank Feet Screen_ Feet <br /> Slot Size: _ <br /> ❑Boring Installationf�8oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> TGravity 75�Trernie ❑Other: Type of Method: <br /> Water ent 471b Water Cement9.11b <br /> allom Ba alluns Ba > <br /> Thickest Th,nnest 'V Bap Thickest Thinnest aBagc Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.1 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 1n 10 20Bentonite per 94 Ib 2.82 4.7 <br /> 71 <br /> 15 15 30 _ <br /> 10 20 4 2 a 2 -�; �,�s w� ga�1 w4 f-u' r buG� <br /> 1?.5 � 15 :55 5 S0 O ` <br /> t5 21 30 nn F _ <br /> 1 7 5 x. 35 Tn <br /> 40 P l b <br /> 12 - : bads - 3 �uCCS �a-�'6/ 7 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />