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SANsJOAQUIN Environmental Health Department <br /> —COUNTY P <br /> c t1 P Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: j �ZnP Inspector: (V1W)3tC � CONSTRUCTION <br /> Facility Address: �Z- 1 S 4,•1 Nc1 +s`�`Ur <br /> Well Address: Total Depth: <br /> WP# t'6 4 l `� Well#: Drilling Rig Type: <br /> Soil Boring#: ` %, 1U A bb - <br /> Drilling Company: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION C _OMPLETION <br /> Method: Ground Surf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> it. <br /> SPOILS <br /> <; = a <br /> Contamination Noted: ❑ Yes El No r <br /> If yes, spoils storage Location: atoned .8 <br /> aK3on _ <br /> Covered: ❑ Yes ❑No <br /> = Brava pack <br /> If yes, material: J <br /> GROUTING or DESTRUCTION Total Depth:Depth to to Water: `® n- tt' <br /> Grout Material: °�wa�P�� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation'-9Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> fh'Gravity ❑Tremie ❑Other: Type of Method: <br /> 1 Water Cement 471b Water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest sBags Thickest Thinnest ttBags 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 /> , \%ClL, 10/16/2017 <br /> 1868 >�E }jazelton-Avenue j--Stoc on California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sicehd.com <br />