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" �°? SAN JOAQUIN <br /> Environmental Health Department <br /> COU N T Y---- <br /> cggr Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Dater J4�31"_ Inspecto : L11 dsa CONSTRUCTION <br /> Facility Address: ita <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: I <br /> Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: N, rol 1ffiY1 U Screen Length From: To: <br /> Driller Onsite: ' <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND CHR__ <br /> Holding Temperature: COWLETtoN Ca4wtFnoN <br /> Method: Ground Sudwe <br /> Screening Method: or«n <br /> Verified Chain of Custody: ❑ Yes ❑No -n' <br /> is. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: atan�d = S <br /> secton '' — <br /> Covered: ❑ Yes ❑No <br /> g-VW Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: :5? <br /> Depth to Water: A fL tt. <br /> Grout Material: curft _ <br /> Gallons of Grout Used: t35 C� robt 1 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> Boring Installation ❑Boring Destruction gags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest tlBags Bentonite/Cement Mix 3% Mix 3% Mix <br /> 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 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />