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SAN�JOAQUIN <br /> Environmental Health Department <br /> i —COUNTY— <br /> Greotness gro:rs <;ere. <br /> MonitortingllW- ell/Soil Boring Inspection Report <br /> 11 Date: ( u Inspector: ��^ SJ Lrl� CONSIRUCl_IO_N_ <br /> Facility Address: I too LM,V k re-vs <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: TIS i _ C-oL <br /> Driller Onsite: 011b�i/` Screen Length From: To: <br /> Consultant: n w0 d� 2{,i A4(e,)Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING <br /> ABOVE-GROUND <br /> Holding Temperature: cowPLETION cCOMPoN <br /> Method: oratind Surface <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑ Yes El No ft- <br /> ft. ft. <br /> SPOILS _ <br /> Contamination Noted: ElYes ❑No r,w <br /> If yes,spoils storage Location: = C <br /> sionad <br /> ssc5en <br /> Covered: ❑ Yes El Nog-�w Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:.. <br /> Depth to Water: ow — tt- <br /> Grout Material: 2.tit C(-rZ'T <br /> Gallons of Grout Used: Y60 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> >btvell Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> 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 /> Qallons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest PBags Bentonite/Gement Mix 3% MIX_ 5% Mix <br /> — — -- — - — <br /> Z5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 1 10 20 2 Bentonite per 94 Ib 2.821 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 1 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />