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SAN ,JOAQUIN <br /> y � _COUNTY— <br /> Environmental Health Department <br /> - Greatness grows here. <br /> 7!�� <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 4 Inspector: l,.✓ C�a CONSTRUCTION <br /> Facility Address: ZIZS w.•i <br /> Well Address: Total Depth: <br /> WP# Dv39y 17 Well#: Drilling Rig Type: <br /> Soil Boring#: X1!1 z v V v .p2�a3 Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: 6L-L <br /> Driller Onsite: (v%,a..�..wlJl Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: rjr; Q.,.a � <br /> 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: WT <br /> height <br /> SAMPLING A VE-GROUND <br /> Holding Temperature: COWLEMN cCoMPPLEnON <br /> Method: Ground Surfaos <br /> Screening Method: Gr(XA <br /> Verified Chain of Custody: ❑ Yes ❑No �--n' <br /> tt. <br /> ft. <br /> SPOILS : <br /> Contamination Noted: ❑ Yes El No <br /> C <br /> If yes,spoils storage Location: slotWd <br /> s�C`on <br /> Covered: ❑ Yes []No = gr,,,W pack <br /> If yes, material: µ = <br /> GROUTING or DESTRUCTION Total Depth: W4 t Z"R- L•+1F�� <br /> Depth to Water: 5, �' n' <br /> Grout Material: r-e.ds <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Usedr-,�!::D� s'6�, �j, Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> � � Slot Size: <br /> ❑Boring Installation Loring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> R/ <br /> Gravity 01 remie ❑Other: Type of Method: <br /> tax <br /> Water Cement 471b Water Cement 941b <br /> gall s Bas allons Bags <br /> Thickest Thinnest 11 Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 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 1 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 1 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 www.sicehd.com <br />