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Grourxt Surface <br />grout <br />ft <br />ft <br />it. <br />SAN.JOAQUIN <br />COUNTY <br /> Environmental Health Department <br />Greatness grows here, <br />Monitoring Well/Soil Boring Inspection Report <br />Date:CONSTRUCTION Inspector: <br />Facility Address: 9—ts OA) <br />Well Address: Total Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring#: i 2, 1 <br />Drilling CompanyAkyr__Sv (-,t)t'eN '"f•R ( <br />Driller Onsite: <br />Consultant: Vtc\--4"'-C'9 <br />Geologist: <br />Min 2" Annular EHD Seal Verified: 0 Yes LINo <br />Screen Length From: To: <br />Filter Pack <br /> <br />From: To: <br />Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: 0 Yes COMPLETION El Stove Pipe OChristie Box <br /> <br />Domestic Well Onsite: 0 Yes V'No <br />If yes, location and distance: <br />SAMPLING 13* <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 0 Yes ON° <br />SPOILS <br />Contamination Noted: 0 Yes I/No <br />If yes, spoils storage Location: <br />01 Yes 41No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: s <br />ez, <br />Depth to Water: \L) 5% 5h. <br />Grout Material: <br />Gallons of Grout Used: <br />DWell Installation 1=IWell Destruction <br />casing <br />height <br /> <br />cfnssrt-Box <br />corytetinoN <br />Covered: <br />slotthd <br />s•cdon <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: El Boring Installation Boring Destruction <br />METHOD USED <br />li1Pressure Grout Over Drill <br />El Gravity Tremie DOther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest 4 Bags <br />2.5 5 10 1 <br />5 o 10 20 2 <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 />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I 1 209 468-3420 I F 209 464-0138 I www.sicehd.com