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2 SAN`JOAQUIN Environmental Health Department <br /> �d <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: X30 / Inspector: X"t CONSTRUCTION <br /> Facility Address: 4) <br /> Well Address: 64" _ ( 'V0 f_ Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: M a sd lis ��, 1 1 r /�� Min 2" Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: ( y 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 El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> CHRIMHolding Temperature: 001"F�ION I:Eno_N <br /> Method: Groind Sud'o• <br /> Screening Method: ofcx+t— <br /> Verified Chain of Custody: El Yes 0 N __1LL__ tt' <br /> it. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: atoned <br /> aa�Jon <br /> Covered: ❑ Yes El No = g-we+tack <br /> If yes, material: / <br /> GROUTING or DESTRUCTION Total Depth: 1 4. <br /> IF <br /> Depth to Water: fL = n' <br /> Grout Material: vl^- � <br /> Gallons of Grout Used: -7 V � o- MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity i�ftremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> Rall s Bas izallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest pBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 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 01 <br /> k ']] <br /> 15 30 6 30 60 6 („ S 50 IkWel� �F ')4r <br /> 17.5 35 7 35 70 7 A �/� yr2� <br /> 20 40 8 1 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 />