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SANJOAQUIN Environmental Health Department <br /> .C.O U N T Y= <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: glll�2�2o Inspector: GA!gt_5(a � r �,.,.t CONSTRUCTION <br /> Facility Address: <br /> Well Address: 11LI 1 C k,6 Total Depth: <br /> WP# 00 14tob 2 We l#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: 11 Yes ❑No <br /> Drilling Company: �S CKP�>!'., AbdoMin <br /> Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: A- <br /> n <br /> -fight <br /> SAMPLING VEt� _ <br /> -GROUND <br /> Holding Temperature: 'cow'L'-T�u �FLE�N <br /> Method: $LO= <br /> Screening Method: grt <br /> Verified Chain of Custody: ❑ Yes ❑No fL <br /> it. <br /> SPOILS <br /> o <br /> Contamination Noted: ❑ Yes ❑No w= = A <br /> a. o <br /> If yes, spoils storage Location: — Q <br /> • Si•.It$d a <br /> aaGaon = — <br /> Covered: ❑ Yes ❑No <br /> ' gae®i peis <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: LOA r <br /> Depth to Water: — <br /> Grout Material: .AtA } ( n <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> [I Boring Installation C� Slot Size: <br /> Boring Destruction Bags Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity EiTremie ❑Other: Type of Method: <br /> Water i cement 471b Water Cement 94 lb <br /> —gaIlons I Baas allons Bags <br /> Thickest Thinnest Bags Thickest Thinnest #Bags Bentonite/Gement Mix 3% Mix 55% 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 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 Qui 30 60 6 <br /> 17.5 35 I 7 35 70 7 <br /> 20 1 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 wwvv.sicehd.com <br />