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='P SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> \4 Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> I <br /> Date: L7,0'0Inspector: i 0- 4 - CONSTRUCTION <br /> Facility Address: -2(qL(N - �opT sf. -C) 1 � � <br /> Well Address: Total Depth: l r tir <br /> WP# 00 y0 y Well#: Drilling Rig Type: 9 ZS - 14S � 6 <br /> Soil Boring#:9 L= 5, Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: l <br /> Driller Onsite: L- <br /> Screen Length From: To: <br /> Consultant: �j �SScG�`a.T�P Filter Pack From: To: <br /> Geologist: D� 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: WT <br /> height <br /> —WW-f <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFL TION LEnoN <br /> Method: G=nd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> ft. <br /> tt. <br /> SPOILS x <br /> V _ e <br /> Contamination Noted: ❑ Yes El No i =` <br /> If yes, spoils storage Location: P' SO i <br /> abttad <br /> ! <br /> _ <br /> Covered: El Yes 1:102- D`5 ' <br /> on <br /> stoned <br /> _ 9, <br /> VW Pack <br /> If yes, material: J <br /> GROUTING or DESTRUCTION Total Depth: j 0-1q <br /> :x _ <br /> Depth to Water: "-W fL tt' <br /> Grout Material: <br /> Gallons of Grout Used: '�2-0 0 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> Ij <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation*oring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> P4 Gravity EZTremille, ❑Other: Type of Method: <br /> Water Cement 71b water Cement 941b <br /> allons Bas allons BaRs <br /> Thickest Thinnest trBags Thickest Thinnest tlBags Bentonite/Gement 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 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> `) 0 y04 <br /> -3 J bis 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 />