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SANJOAQUIN Environmental Health Department <br /> '. <br /> --COUNTY— <br /> Greatness <br /> -COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: MD✓M1 Inspector: '..CJ����S CONSTRUCTION <br /> FacilityAdd rens: <br /> _ 5�� 1��t.'��aG+ <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: L1 Yes []No <br /> Drilling Company: CZ <br /> Driller Onsite: li <br /> Screen Length From: To: <br /> Consultant: <br /> tm\Ap-�()r� CAVDA Filter Pack From: To: <br /> Geologist:_ Bentonite From: To: <br /> g �r�L�n. <br /> 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: lfftl height <br /> off— <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: corF�nON comPLEnoN <br /> Method: °roan°Sudo <br /> Screening Method: groLd <br /> Verified Chain of Custody: ❑ Yes ❑No �ft' <br /> it. <br /> tt. <br /> SPOILS . <br /> a <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted <br /> sicson ."� <br /> Covered: ❑ Yes ❑No = 9-1 P-* <br /> If yes, material: ` <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: Q( ky • tt. <br /> �mn' <br /> Grout Material:J�PJ -Q-!e&efA. MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> e: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation XBoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> Fall s Bas eallons Baes <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5% Mix <br /> 2.5 5 1 10 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 /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />