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SAN :JOAQUIN Environmer►__I Health Department <br /> -COUNTY— <br /> Greatness gro,s here. <br /> Monitoring Well/Soil Boring Inspection Report ��� �g.•`l�' <br /> Date: 3��� Inspector: /,*ez--os& CONSTRUCTION <br /> Facility Address: yO r) . <br /> Well Address: Total Depth: <br /> WP#bD`7���� WW1 ell#: Drilling Rig Type: <br /> Soil Boring#: 7S6-eV-3Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 4.o <br /> Driller Onsite: ,TL,4— A4,-4,z- Screen Length From: To: <br /> Consultant: Filter Pack From: To: <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 casing <br /> If yes, location and distance: 1HT height <br /> SAMPLING AWVE.GROUND <br /> Holding Temperature: COWLETION COMPt.E7IoN <br /> Method: Ground Surface <br /> Screening Method: Aron <br /> Verified Chain of Custody: ❑ Yes ❑No i �ft. <br /> ` ft. <br /> SPOILS ft. <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stottne = <br /> s�c5an — B <br /> Covered: ❑ Yes ❑No <br /> Q-Vlw Pack <br /> If yes, material: _ EE <br /> GROUTING or DESTRUCTION Total Depth: �Zd <br /> Depth to Water: /t/d 6K/ ft• <br /> RE ft. <br /> Grout Material: *4" CPQ r <br /> Gallons of Grout Used: 3�y✓ y� ,��,6�. MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout []Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> T�Gravity ❑Tremie ❑Other: Type of Method: <br /> ate'r Cement 471b Water Cement 94 lb <br /> allo Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 s 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s to kv 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 1 8 40 80 8 <br /> �L7 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 />