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SAN JOAQUIN <br /> �. COUNTY Environmental Health Department <br /> q� resy Greatness yreris here . <br /> Mo 'n' itoring Well /Soil Boring Inspection Report <br /> Date : SI Za � Z- Inspector : �('c 44A C buf << . CONSTRUCTION <br /> Facility Address . <br /> Well Address : 5& 4;7 $ & � gkKy t Total Depth : <br /> WP #� I/ .S� Well # : A A1b(; � 7, 3 Drilling Rig Type , <br /> Soil Boring# . <br /> Drilling Company : Min 2 " Annular EHD Seal Verified : ❑ Yes ❑ No <br /> �► ` � <br /> Driller Onsite : Screen Length From : To : <br /> Consultant : � : ; Filter Pack From : To : <br /> Geologist : Bentonite From : To : <br /> Grout From : To : <br /> Public Water System Onsite : ❑ Yes ❑ No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes ❑ No casing <br /> If yes , location and distance : height <br /> SAMPLING AWVE,oGAouND <br /> Holding Temperature : COMPLETION e4401RIm-sox <br /> Method : Ground swla►cs — <br /> Screening Method , groat <br /> Verified Chain of Custody : ❑ Yes ❑ No ft- <br /> fte <br /> SPOILS <br /> m <br /> Contamination Noted : ❑ Yes ❑ No .= <br /> If yes , spoils storage Location : ' .= s <br /> slottad _ c <br /> Covered : ❑ Yes ❑ No _ 1 <br /> ack <br /> If yes , material , f <br /> GROUTING or DESTRUCTION Total Depth : ` © — <br /> Depth to Water : _.______ ft. it. <br /> Grout Material , NA4 <br /> Gallons of Grout Used : MATERIALS/ DEVELOPMENT <br /> Casing Type : <br /> ❑ Well Installation Well Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> El Boring Installation El Boring Destruction Bags of Cement : <br /> METHOD USED Bags Sand /Gravel : <br /> ❑ Pressure Grout ❑ Over Drill Type/ Brand of Bentonite : <br /> Filter Pack Type/Size : <br /> ElGravity ATremie ❑ Other : Type of Method , <br /> Water cement71 Water Cement 94 lb <br /> allons Bas gall ons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest it Bags Bentonite/Gement Mix 3 % MIX 5 % MIX <br /> 2. 5 5 1 5 10 1 Bentonite per 47 Ib 1 .41 2 .47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2082 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 /> 1 � � N75 <br /> 10/ 16/ 2017 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468- 3420 F 209 464-0138 www . sicehd . com <br />