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Q> ° , SAN JOAQUIN <br /> Environmental Health Department <br /> "1 - COUNTY <br /> \cgii Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:V�7",� Z'o Inspector: ` a_ /' ' CONSTRUCTION <br /> Facility Address: Jl W. G� /- <br /> Well Address: Total Depth: i- <br /> WP# o '�[6 Well#: Drilling Rig Type: �{- <br /> Soil Boring#: /— <br /> Drilling Company: V X Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: r1 Screen Length From: To: <br /> Consultant: >� Filter Pack From: To: <br /> Geologist: <br /> 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: height <br /> ii <br /> SAMPLING ABOVE-GROUNO <br /> Holding Temperature: OOi``FLETION cCC#APtEnON <br /> Method: Grvrr'cl S"r'"' <br /> Screening Method: Mt <br /> ofO"t <br /> Verified Chain of Custody: ❑ Yes El No �tt. <br /> n. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> C <br /> If yes,spoils storage Location: <br /> s*c;on _ <br /> Covered: ❑ Yes ❑No = - qrz rW v..k <br /> If yes, material: •2L2I� <br /> GROUTING or DESTRUCTION Total Depth: 92,17-01 <br /> Depth to Water: noki n3. 101 <br /> Grout Material: J1.e6` 8 <br /> "- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation L4Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 7Ib Water Cement 94 lb <br /> N <br /> ns Bas allons Ba s <br /> Thinnest 4Bags Thickest Thinnest NBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 5 1 5 10 1 Bentonite er 47 Ib 1.41 2.47 <br /> 10 2 l0 20 2 Bentonite er 94 Ib 2.82 4.715 3 15 30 320 4 20 40 4 <br /> 12.5 25 5 25 1 50 5 <br /> 15 30 6 30 1 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> S4 �^ ay 5 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 />