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D�UUIN C <br /> SAN:]OAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �' �� Inspector: AAE' CONSTRUCTION <br /> Facility Address: 112-1 Okct� .4--t <br /> Well Address: Av Total Depth: <br /> WP# ev S//Od2 Well#: Drilling Rig Type: <br /> Soil Boring#: „ <br /> Drilling Company: G•/� 6M-� Min 2 Annular EHD Seal Verified: El Yes 11 No <br /> Screen Length From: To: <br /> Driller Onsite: /y1 <br /> Consultant: � <br /> .. 4 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: T height <br /> 59 —WW7:F <br /> SAMPLING ^'1 sd� AWVE-GROUND <br /> Holding Temperature: d CONFLET'ON C)&UnEnCN <br /> Method: , ,f CirvundSurfac. <br /> Screening Method: •'`� <br /> proof <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> f <br /> ft. t. <br /> SPOILS = <br /> K.. �• <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: Al if .baa <br /> �� <br /> Covered: ❑ Yes El No <br /> Jed <br /> vRw+pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: S� �S� n• tt. <br /> Grout Material: /Vw otwGw 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 ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> 250't <br /> / Filter Pack Type/Size: <br /> El Gravity remie �ther:f''k- Type of Method: <br /> o rpt! N..ILP, <br /> at r Ce t)47 Water Cement 941b <br /> alto allons Bags <br /> Thickest Thinnest NBags Thickest Thinnest 4Bags 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 e� el <br /> 12.5 25 5 25 50 5 fdfs� <br /> 15 30 6 30 60 6 !,/ �f <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 1 8 L <br /> -), /Oy Z9 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />