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SAN,JOAQUIN* <br /> COUNTY— Environmel Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1 2 ! Inspector: -r- »L irowrt CONSTRUCTION <br /> Facility dress: � �0� sr ,..L ft r, <br /> Well Address: M * v Total Depth:S_ <br /> WP# '�1AOH Well#: kA W- 47M Drilling Rig Type: w 1 tt� <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: [Yes []No11A t <br /> Driller Onsite: 060vvb t Screen Length From: .9 To:�� <br /> Consultant: L k C w ,�A vyk4. Filter Pack From: P3? To: (o Z <br /> Geologist: (( 1 Bentonite From: G'S• To: 6 l <br /> Grout From: To: 60 <br /> ❑ _ <br /> Public Water System Onsite: Yes No COMPLETION El Stove Pipe ,Christie Box <br /> Domestic Well Onsite: 11 Yes KNo casing l <br /> If yes, location and distance: height <br /> SAMPLING <br /> ABOVE-GROUND CHRIM-BOX <br /> Holding Tempe COMPLE ION COMPLETION <br /> Method: Ground suTao. 7_ <br /> Screening hod: grout <br /> Verified Chain of Custody: ❑ Yes ❑No 6l n• <br /> SPOILS <br /> Contamination Noted: ❑ Yes ?ZNo �. <br /> If yes,spoils storage Location: <br /> &scdon = E <br /> Covered: ❑ Yes ❑No _ g-%Vl <br /> If yes, material: paCk <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ls> n. <br /> Grout Material: 1� <br /> Gallons of Grout Used: 1 :3 7 MATERIALS/DEVELOPMENT <br /> Casing Type: SVS 40 TV c <br /> 1Well Installation ❑Well Destruction Blank t,S, Feet Screen 2u Feet <br /> ❑Boring Installation ❑ Slot Size: (2 .m-C,7Boring Destruction Bags of Cement: -5o <br /> METHOD USED Bags Sand/Gravel: l3 <br /> ❑Pressure Grout []Over Drill Type/Brand of Bentonite: 4 <br /> /// Filter Pack Type/Size: Z l2 <br /> El Gravity L14Tremie ❑Other: Type of Method: <br /> Water /Cement 471b Water Cement 941b <br /> Mons Baes M1111ons Baus <br /> Thickest Thinnest #Bags Thir est Thinnest #Bags Bentonite/Cem % Mix <br /> ent Mix 3% Mix 5 <br /> 2.5 5 1 5 10 1 Bentonite 2er 47 Ib 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb2.82 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 3o 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 1 40 B 1 40 80 8 <br /> 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 />