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grout <br />ft <br />SAN JOAQUIN <br />Date: 6549/zi Inspet t/bir: <br />Facility Address: S <br />i <br /> <br />Well Address: <br />WP (.901-1 o2- I IO Well#: <br />Soil Boring#: H A -)PA- 5 <br />Drilling Company: t.o-rk. eAt La2_ Ckli,i'retter ,-Wrt‘—/ <br />54-..-i-ics4Screen Length <br />Filter Pack <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Yes ON° <br />To: <br />To: <br />To: <br />To: <br />COUNTY <br />GieutovNs grows <br />Monitoring Well/Soil Boring Inspection Report <br />A-• CONSTRUCTION <br />Environmental Health Department <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: <br /> <br />From: <br /> <br />From: <br />Bentonite From: <br />Grout From: <br />Public Water System Onsite: LI Yes EINo COMPLETION LI Stove Pipe OChristie Box <br /> <br />Domestic Well Onsite: LI Yes <br /> <br />111No casing <br />height <br /> <br />If yes, location and distance: <br /> <br />SAMPLING <br />Hold ng Temperature: <br />Method: <br /> <br />ABOVE-GROUND <br />CC MP LE710 N <br /> <br />CHR :STY-BO X <br />COMPLE71CN <br /> <br />Ground Surf a4s <br /> <br />Screening Method: <br /> <br />Verified Chain of Custody: <br /> 1E1 Yes ONo <br />SPOILS <br />Contamination Noted: <br />GROUTING or DESTRUCTION Total Depth: 26 <br />Depth to Water: 401412-1 <br />Grout Material: nok-r Co4ra,y•--71- <br />Gallons of Grout Used: <br />OWell Installation El Well Destruction <br />El Boring Installation Boring Destruction <br />METHOD USED <br />El Pressure Grout DOver Drill <br />Gravity OTremie DOther: <br />Water <br />gallons <br />Cement 47 lb <br />Bags <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest B Bags Thickest Thinnest g Bags <br />2.5 5 1 5 10 1 <br />5 10 , 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 8 413 80 0 <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <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 />1=1 Yes ON° <br />If yes, spoils storage Location: RA- 2: 11 —) re-Asr,- <br />a la rtad <br />7' <br />Covered: El Yes oN014A-3.: 5 , <br />: g' If yes, material: PA- Li <br />ft FM <br />tirctcn <br />ft <br />1868 EiHazelton Avenue I Stakton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com