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SAN_JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:L 12 U iF41nspector: �6 CONSTRUCTION <br /> Facility Address-q), 21 -z.,"\ S - <br /> Well Address: N.P, - 1C-NS Total Depth: <br /> WP#�►.t�q,5 �Z\b-'�i Mti V�3 Well#: � Drilling Rig Type: <br /> Soil Boring#:'�>�,- . !?Z' t Irl P Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> DrillingCompany:��rrsc t_eA�� �xQt�t-pt�%,a <br /> Driller Onsite: ?—Ac C\r-\ Screen Length From: To: <br /> Consultant:S-C k /F Fi er Pick From: To: <br /> Geologist:�O. C�-��`. Ben onite From: To: <br /> 11 Grout From: To: <br /> Public Water System Onsite: 11 Yes �1No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: Yes ❑No casing <br /> If yes, location and distance: IHT height <br /> SAMPLING IJ I gyp, ABOVE.-GROUND ci-isls-ry-poX <br /> Holding Temperature: Coh?LEMN COMPLETION <br /> Method: G=ndSLxf- .-� <br /> Screening Method: 9r1►O1i <br /> Verified Chain of Custody: ElYes ❑No ft. <br /> it. <br /> fi. <br /> SPOILS <br /> r = � <br /> Contamination Noted: ❑ Yes Po `` <br /> If yes, spoils storage Location: s>otsod _ - <br /> xoc9on <br /> Covered: El Yes FINO 7 pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth?D i\S t�0 t'LO \� I \'D� I\D <br /> Depth to Water: k n' n' <br /> Grout Material: <br /> Gallons of Grout Used: "1 S MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation f Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> / Water Cement 471b Water Cement 941b <br /> gallons Bas alIII ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest ttBags Bentonite/Cement Mix 3% MIX 5%MIX <br /> 2.5 s 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 z 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 />