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-c"`"•� � SAN�JOAQUIN <br /> Environmental Health Department <br /> COUNTY— <br /> ., <br /> '••:�ti�og''- Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: NIS 11 q Inspector: K.SCaetP ren CONSTRUCTION <br /> Facility Address: 6c)n 16. moc daale <br /> Well Address: Total Depth: <br /> WP# 0040!, R4 Well#: Drilling Rig Type: 4" mud rotary <br /> Soil Boring#: Eb#•t4E.®3tj, Fe'w' Min 2"Annular EHD Seal Veliified: ❑Yes ❑No <br /> Drilling Company: �( W O r���Prr► <br /> Driller Onsite:_A � 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 E]No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING AIMVIS-GROUND ct ssTYao <br /> Holding Temperature: COWLEiION CHMSN- x <br /> 10 <br /> Method: C3odnd Sumace <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No n. <br /> s. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: #� s <br /> src�on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: G1.5-�k t9l'lb <br /> Depth to Water: un{cnoywn mtnrq Jr <br /> Grout Material: Lvea't cernent- <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction tri- <br /> Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation $Boring Destruction Bags iz Cement: <br /> METHOD USED b snroM� Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity §4Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> gallons Bags Rna Ilons Bags <br /> Thickest Thinnest >rBags Thickest Thinnest NBags Bentonite/Cement MIX 3%Mix 5% Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 lb 1.41 2.47 <br /> . 15 2 15 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 �Ic Cema +?5c}�re brpkQ <br /> Qte`C COm� �n9 <br /> 15 30 6 30 60 6Q om �x- 4E�J 3 <br /> 17.5 35 7 35 70 7 .J <br /> 20 40 8 40 80 8 <br /> `w gc�L 15 bards 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 />