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'°U'" SMJOAQUIN <br /> Environmental Health Department <br /> COU NTY- <br /> �9��,Foa Greatness grows here, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 01 20 Z1 Inspector: Illv-v CONSTRUCTION <br /> Facility Address: 2k—4Gr. _r, � Y . <br /> Well Address: 6QAL0✓) Total Depth: <br /> WP# ( AkP ) Well#: Drilling Rig Type: <br /> Soil Boring#: k Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: Zcck7cxn taesocia-�e S Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: zain 1 1115506a C. Filter Pack From: To: <br /> Geologist: _ pU,IAm. <br /> Bentonite From: To: <br /> 1 Grout From: To: <br /> Public Water System Onsite: ❑ Yes El 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: CO�"F�ION cc#AP�t_EncN <br /> Method: Ground Surface <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes El No �tt. <br /> tt. <br /> ft. <br /> SPOILS : <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: afonad <br /> sac�on _ <br /> Covered: ❑ Yes ❑No = gw+P­k <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tt• — tt• <br /> Grout Material:.NN A Cf wnk- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation RWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED QJC�L'�� \", Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill � b !�` Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ITremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Gement 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 v 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 V 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 /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />