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UIA <br /> SAN4JOAQUIN <br /> Environmental Health Department <br /> ` - COUNTY <br /> Greatness grows here. <br /> p Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: w CONSTRUCTION A <br /> Facility Address: Sn V. 4' �qV <br /> Well Address: Total Depth: <br /> WP# Well#r Drilling Rig Type: <br /> Soil Boring#: 'S&% k t'1 sm 5�+�. �C'C <br /> Drilling Company: My ou(` jA%� (� -� .Min 2"Annular EHD Seal Verified: F1 Yes El No <br /> Driller Onsite: /, Screen Length From: To: <br /> Consultant: SCa� ` $ �0 , 5 �tc�5 a ASS 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 ❑Nocasing <br /> If yes, location and distance: IT height <br /> 71, _qw—f <br /> SAMPLING ABOVE-GRCUhD <br /> Holding Temperature: COWLETrcra c^ttise o� <br /> Method: a.tx,nds�rr "�--- <br /> Screening Method: cr«t <br /> 1 <br /> Verified Chain of Custody: ❑ Yes El No T n <br /> SPOILS - <br /> �r _ <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> slatted C <br /> Covered: ElYes ❑Nocn <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 41= <br /> _ <br /> Depth to Water: j 3 \ , �{ %Z —tL — i ft. <br /> Grout Material:. M&*_S'N C&19ZN ® h" MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: N <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen _Feet <br /> Size: <br /> ❑Boring Installation N Boring Destruction Bags Slot Siziz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over-Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity gTremie ❑Other: Type of Method: <br /> Water Cement 471b ;Yater Cement 94 lb <br /> gallons Bas RaI1111 ons Ba s <br /> Thickest Thinnest 4Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3%Mix 3%Mix <br /> 2.s 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />