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SAN J OAQ U I N Environment`-. Health Department <br /> —COUNTY— <br /> Gr.c:.,_>, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: -7-1-19 Inspector: &p.sE 4"— CONSTRUCTION <br /> Facility Address: ttys w• c deaf E�� r <br /> Well Address: Total Depth: <br /> WP 0DR6W Well#: Drilling Rig Type: <br /> Soil Boring#: Ave <br /> Drilling Company: 604--4,16 Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Screen Length From: To: <br /> Driller Onsite: ,p1Y <br /> o Filter Pack From: To: <br /> Consultant: G <br /> Geologist: 'Zo�ek 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 casing <br /> If yes, location and distance: T height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COt"P�1ON COIMPPLEMON <br /> Method: °`°""d Surface <br /> Screening Method: M, arocrt <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> fi. <br /> ft. <br /> SPOILS <br /> - - o <br /> Contamination Noted: ❑ Yes El No " _ r <br /> If yes,spoils storage Location: slattod <br /> sac5on — <br /> Covered: ❑ Yes El No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ' _ __ <br /> Depth to Water: n- n' <br /> Grout Material: /Uas e4eA0_. ¢ <br /> Gallons of Grout Used: low- MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation g Slot Size: <br /> C3°Borin Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity LJTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest tt Bags Thickest Thinnest #Bags 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 941b 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 /> 1s 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 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />