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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring/Well/Soil Boring Inspection Report <br /> Date: 512 SIP <br /> —70Inspector: CONSTRUCTION <br /> Facility Address: S o j A�t-t/ <br /> WellAddress: ✓Total Depth: <br /> WP# 106 qWell#: Drilling Rig Type: <br /> Soil Boring#: 62 11 jgq <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes 11 No <br /> Driller Onsite: ✓t Qi Screen Length From: To: <br /> Consultant: ;✓l-4t Filter Pack From: To: <br /> Geologist: p„o 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 —r— casing <br /> If yes, location and distance: T height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION CCCUPt..ET1oN <br /> Method: Ground Surtac* <br /> Screening Method: gfout <br /> Verified Chain of Custody: ❑ Yes El No �tt. <br /> ft. <br /> ft. <br /> SPOILS k <br /> Contamination Noted: ❑ Yes ❑No <br /> MIf yes, spoils storage Location: slotted <br /> soc}on = <br /> Covered: El Yes ❑No g,,,Wpack <br /> If yes, material: 4 <br /> GROUTING or DESTRUCTION Total Depth: T �� A• =_ <br /> Depth to Water: 00 tt. tt' <br /> Grout Material: <br /> Gallons of Grout Used: �— MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation�Boring Destruction Slot Size: <br /> (( Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ' ravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 71b Water Cement 941b <br /> allons Bas gaill ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags 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 z 10 zo 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 /> (20 9 Yom! �0 n n ( 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 I www.sicehd.com <br />