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SAN"JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greotness qro.vs here. <br /> / Monitoring Well/Soil Boring Inspection Report <br /> Date: (Z� Inspector: Cil J v C ( CONSTRUCTION <br /> Facility Address: 22 I W. `1'i e <br /> Well Addgress: Total Depth: <br /> WP#_ CX) 11 ,?'T Well#: — Drilling Rig Type: <br /> Soil Boring#: `-- Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: ;-6:h t&/ <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Willy <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> iii <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: GOI.g'LET10N COMP�LETiON <br /> Method: Qrcund Surtabcs' +'— <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑ Yes ❑No �ft' <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: K-Yes ❑No r' <br /> If yes,spoils storage Location: qL r e, t_p� <br /> 410nad _ — <br /> wecden <br /> Covered: ❑ Yes DI No = g„ <br /> If yes, material: ' <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: lz <br /> n' <br /> Grout Material: e k CQr-4t,7— MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ou y c h�O "7�(A•) <br /> Casing Type: <br /> ❑Well Installation Nell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grouter Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags eall s Bags <br /> Thirkest Thinnest ! Bags Thickest Thinnest aBags Bentonite/Cement 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 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 i <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 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />