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SAN�JOAQUIN <br /> f� sd NTY Environmental Health Department <br /> !i�, Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �`tiLl�? Inspector: �utu4L, `� t CONSTRUCTION <br /> Facility Address: <br /> Well Address: 1��� �� e��I� �� ( Total Depth: <br /> WP# co 10�$ Well#: Drilling Rig Type: <br /> Soil Boring#: \,`r� <br /> Min 2 Annular EHD Seal Verified: ❑ Yes 11 No <br /> Drilling Company: <br /> Driller Onsite: '1cic�. Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: AjoI- ���orP Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> tt <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COLVLCM <br /> fiTION COPLE7toN <br /> Method: Gmnd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �n• <br /> n. <br /> n. <br /> SPOILS <br /> = e <br /> Contamination Noted: ❑ Yes EJ No <br /> If yes, spoils storage Location: <br /> slatted <br /> s�c4on r <br /> Covered: ❑ Yes ❑No <br /> If yes, material: \ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tL JL <br /> Grout Material: �t.� � Cau��L <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation-qBoring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill c Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie 00ther: ' Y4.�� Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest »Bags Thickest Thinnest #Bags 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 <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 8 <br /> 10/16/2017 <br /> } <br /> 1868 E. Hazelton Avenfae-I }Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />