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°U'�,pP SANsJOAQUIN <br /> Environmental Health Department <br /> " <br /> COUNTY--- <br /> Greatness <br /> OUNTY-- <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z Inspector: i o•n CONSTRUCTION <br /> Facility Address: ]L.,-7-7-7 .,al f er- 1 <br /> Well Address: lt�SkY MTotal Depth: L <br /> WP# 063flSL171� 6 —Welk ru—y 3 Drilling Rig Type: So✓wC� <br /> Soil Boring#: C1 <br /> Drilling Company: ,, Min 2"Annular EHD Seal Verified: Ga'�es ❑No <br /> Driller Onsite: (�Yr.,,.r r Screen Length From: I''-Z,&49 To: "D444 "L-7-7 <br /> 1� <br /> Consultant:�,�� Filter Pack From: `Z5To: L7 y <br /> Geologist: Bentonite From: _To: <br /> Grout From: (2 To: <br /> Public Water System Onsite: EJ Yes ❑ _ <br /> No COMPLETION L`�Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING nsove-GROUND <br /> Holding Temperature: COt"P�ION EnoN <br /> Method: Ground Surface <br /> Screening Method: ori <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> h. <br /> SPOILS <br /> Contamination Noted: ❑ Yes E]No r° <br /> If yes, spoils storage Location: sbtzad <br /> sac4on +' — B <br /> Covered: El Yes ❑No _ g-w+Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> • _= <br /> Depth to Water: J ft .M tt' <br /> Grout Material: h•u-' ecww <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: t-1 60 <br /> [ ell Installation ❑Well Destruction Blank —(,W Feet Screen W Feet <br /> Slot Size: • o L <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: M <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> �� Filter Pack Type/Size: <br /> EJ Gravity Dl'remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest NBags 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 _ jl/�µk(iy I os' Q �at� 1n. W G U <br /> 12.5 25 5 25 50 5 1 <br /> 15 30 6 30 60 6 �.,t� W•'k ..- <br /> 17.5 35 7 35 70 7 <br /> 20 ao s ao eo s <br /> ✓w 4— �� � S"}�-eb�.Qj �o �n r4¢-4s rc �Ce�l Cly^`". 0/16/2017 <br /> . a 9 <br /> lot <br /> 1868 EF FlazPiton Avenue Stockton, Californi5205 T 209 468-3420 1 ll� 209 464-0138 1 www.sicehd.com <br />