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1r SAN JOAQUIN <br /> �w � � — COUNTY— <br /> Environmental Health Department <br /> Greutness grows here. <br /> / Monitoring Well/Soil Boring Inspection Report <br /> Date: 7r�IZr,z+ Inspector: (e, CONSTRUCTION <br /> Facility Address: , <br /> Well Address: pr of S LA4,-,,, Total Depth: G <br /> WP# ( O�tiv Well#: Drilling Rig Type: Iti l r' .40, <br /> Soil Boring#: <br /> Drilling Company: V&W I`,\\: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: <br /> 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: cor��►ON ccoomPLEnON <br /> Method: Ground Sumacs <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes ❑No �ft' <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: slonad _ B <br /> sac.on <br /> Covered: ❑ Yes ❑No - g,,,iW pack <br /> If yes, material: t< <br /> GROUTING or DESTRUCTION Total Depth: go =_ <br /> Depth to Water: \�' <br /> Grout Material: t4,L ( , 1,� �� 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 QBoring Destruction <br /> 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 /> ❑ Gravity PTremie ❑Other: Type of Method: <br /> at Cement 7{ Water Cement 941b <br /> all ns Bas eallons Bags <br /> Thidrest Thinnest 4Bags Thickest Thinnest uBags Bentonite/Cement Mix 3% Mix S%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 /> zo ao s ao eo e s 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />