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SAN JOAQUIN Environmental Health Department <br /> - COUNTY— <br /> Greatness grows here. <br /> Monitoring /Well/Soil Boring Inspection Report <br /> Date/ ' ! i�"L� Inspector: I ( �T CONSTRUCTION <br /> Facility Add ress:77g5j 0 re- A r��i-C, <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: ( - a T P I I P12- <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> �` Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: 1.2.1 v� <br /> Filter Pack From: To: <br /> Geologist: Mt U pvt/� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> OHolding Temperature: cowu--7t°N �EnN <br /> Method: Ground Surface <br /> Screening Method: I ' 30 grout <br /> Verified Chain of Custody: El Yes El No <br /> ��' <br /> ft. <br /> SPOILS <br /> V 52 — <br /> F — o <br /> Contamination Noted: ❑ Yes El No ,�5 ZOO <br /> If yes, spoils storage Location: O s{o <br /> [ ttad <br /> secdon <br /> Covered: ❑ Yes []No <br /> 6 ' S <br /> t-+ <br /> If yes, material: 1949 - S f �l� <br /> GROUTING or DESTRUCTION Total Depth: R to , <br /> req' , _ <br /> IF <br /> Depth to Water: we- n- n' <br /> Grout Material: P7 • MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ti D� o VlS P�•?J <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation 05oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> N Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Ceme 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest J1 Bags Thickest Thinnest >rBags 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 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 100 O f1,. I O [ s 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />