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S <br /> ;= z.. SAN.:JOAQUIN Environmental Health Department <br /> --COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspect CONSTRUCTION <br /> Facility Address: C' 11C�-�C 11 . <br /> Well Address: Total Depth: <br /> WP# 04 t 5I Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: c ((,I. f �< � Min 2"Annular EHD Seal Verified: 1:1 Yes ❑No <br /> Driller Onsite: <br /> Screen Length From: To: <br /> Consultant: C(;( Z,��. Filter Pack From: To: <br /> Geologist: k Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: 0016FP ETION COMPLETION <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt' <br /> n. <br /> tt. <br /> SPOILS . <br /> Contamination Noted: ❑ Yes ❑No <br /> C <br /> If yes, spoils storage Location: slatted = . <br /> soon <" <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: t ham-- n• — n <br /> Grout Material: ' a <br /> Gallons of Grout Used: � 4s.. MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Lk hr_oj Blank Feet Screen Feet <br /> U ,c� 1 <br /> ❑Boring Installatiororing Destruction Slot Size:Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout []OverDrill Filter Pack Type/Size: <br /> ,Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest xBags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 s 1 5 10 1 Bentonfte per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonfte per 94 Ib 2.82 4.7 <br /> 7.5 35 3 15 30 3 <br /> 30 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 /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />