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" SAN JOAQUIN <br /> N. Environmental Health Department <br /> ---COUNTY <br /> Greatness grows here. <br /> Monitoring/Well/Soil Boring Inspection Report <br /> Date:1_/1 Inspector: a�-(a J7 . CONSTRUCTION H �A <br /> ►1 : () r'Z01 <br /> Facility Address: 02 02 O Ist- <br /> Well Address: Total Depth: L_ J, L� ?—Cg_S- <br /> WP# � dype: 4o Well#: Drilling Rig Ty <br /> Soil Boring#: <br /> Min 2" Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: i ( igo <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: pa CUr Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes EJ No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: 17 height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION COhonET1oN <br /> Method: G=nd Sulwe <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes El No �n' <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: <br /> s+cdon <br /> Covered: ❑ Yes []No cnw+pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total De th:�-�� '• __ <br /> Depth to Water: n' <br /> Grout Material: <br /> Gallons of Grout Used: q D- 10 OS MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation"Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity X,Tremie ❑Other: Type of Method: <br /> Water Cement,',) <br /> emen 471, water Cement 94 lb <br /> allons Bas Mons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest uBags 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 /> 10 204 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 /> -3( 9 0-111 ID ns I O �5 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />