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SAN_,JOAQUIN ' <br /> Envir©nmenlal Health Department <br /> —COUNTY= <br /> Greatness grows here. <br /> (� J Mon1it�oring Well/Soil Boring Inspection Report <br /> Datd'6 Inspector: IV V CONSTRUCTION <br /> Facility Address: Mtn Yt�Q/Y I <br /> Well Ad es : ►R T Total Depth: j air _ Q,{� <br /> WPN 0 tl 2 J Drilling Rig Type: d' <br /> Soil BoringN: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company:Driller Onsite: Screen Length From: To: <br /> P h <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 ❑No caging <br /> If yes,location and distance: � height <br /> SAMPLING ABOVE-&ROUND CFIRIBTY eOX <br /> Holding Temperature: COMF'LErION comp noN —� <br /> Method: Grcdnd3 i°"7 ___ <br /> Screening Method: <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> SPOILS <br /> 1� Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: = s <br /> aks44d t = 3 <br /> aK7on �j = <br /> Covered: ❑ Yes ❑No = graval pack <br /> If yes, material: 1=1_ <br /> GROUTING or DESTRUCTION Total Depth: G - <br /> DepthtoWater: n <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Ga Ions of Grout Used: <br /> Casing Type: -Ye-( IUYI _+Hh-e— <br /> Well Installation ❑Well Destruction Blank Feet Screen QT. 5 Feet <br /> El Boring Installation ❑Boring Destruction Slot Size: n u <br /> Bags of Cement: 7-- <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> I Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement471b Water Cement 941b <br /> Ilons Bags allons Bags <br /> Thickest hinnest #B Thickest Thinnest #Bay _Bentonite(Cement Mix 3% Mix 5°/a Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47lb 1AII 2A7 <br /> 5 10 10 20 z 1 Bentonite per 94 lb 2.82 7 4. <br /> 7.5 is 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 11.5 15 s 25 50 5 <br /> 1s 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 6 1 40 BO 3 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />