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SAN JUAUUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: l(Lti1� Inspector: , "a Qk,.i CONSTRUCTION <br /> Facility Address: <br /> Well Address: 3-70,o �Fixv�,,, G� _ SLQ el_k, Total Depth: <br /> WP# QZ tAv4\0 Well#: Drilling Rig Type: <br /> Soil Boring#: - 1-1 - on <br /> Drilling Company: 0 C�t Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> � �}, <br /> Driller Onsite: —��^ T Screen Length From: To: <br /> Consultant: \ \fit 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 ABOVE-GROUND _ <br /> Holding Temperature: COMPLETION ccwPLETION <br /> Method: Ground Sudacs <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes El No �tt- <br /> R. <br /> n. <br /> SPOILS " <br /> a <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted <br /> soon — 2 <br /> Covered: ❑ Yes ❑Nogrz= �w t <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: . S <br /> Depth to Water: Z�1 �� fL — tt. <br /> Grout Material: IV u. CQ,v�+r�� <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ) Boring Destruction Bags of Cement: <br /> METHOD USED II Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity T remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas SRIall ons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 3% 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 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 1 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 1 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 />