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SANJOAQUIN Environmental Health Department <br /> —.C.O U N T Y= <br /> Greatness grows here. <br /> Monitoring Weil/Soil Boring Inspection Report <br /> Date: V. Inspector: CONSTRUCTION <br /> Facility Address: Cewwtll of X//('�tT/ <br /> Well Address: Total Depth: <br /> WP# ('440( Well#: Drilling Rig Type: 1TI <br /> Soil Boring#: (-C ff-3 <br /> Min 2"Annular EHD Seal Verified: ❑ Yes E]No <br /> Drilling Company: �L.v -- x <br /> Driller Onsite: ./I///(A Screen Length From: To: <br /> r <br /> Consultant: '�V(. Filter Pack From: To: <br /> <h <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No 81mG <br /> If yes, location and distance: eight _ <br /> SAMPLING <br /> vr-GncUrrD <br /> Holding Temperature: cowLE icnF o <br /> Method: ' $' <br /> Screening Method: 0 .,t <br /> Verified Chain of Custody: ❑ Yes ❑Noft <br /> SPOILS � - <br /> . <br /> Contamination Noted: ❑ Yes ❑No {= — p <br /> T. R <br /> If yes,spoils storage Location: _ <br /> aFort�i � <br /> Covered: ❑ Yes ❑No <br /> If yes, material: ._ <br /> GROUTING or DESTRUCTION Total Depth: . __ <br /> Depth to Water: 1V -` <br /> IF <br /> Grout Material- C mt.-N MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> ❑Boring Installation Slot Size: <br /> Boring Destruction Bags Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ipTremie ❑Other: Type of Method: <br /> water, Ceme Ib Water Cement 94 lb <br /> '617, 8 s gallons Bags <br /> Thickest Thlnnest #Bags Thickest Thinnest #Bags Bentonite/Gement Mix 3% Mix 5% Mix_ <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 10 20 4 1 20 40 <br /> ` 12,5 25 5 25 s0 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 40 80 B <br /> Vb 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 www.sicehd.com <br />