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SAN J O A Q U I N Environmental Health Department <br /> - COUNTY -- <br /> r &eatnflss gross here . <br /> Monitoring Well /Soil Boring Inspection Report <br /> Date : 1771 ` �-�- Inspector : toter( � n CONSTRUCTION <br /> Facility Address : e 224� > � . v�nLr � t:�'� y 14,E T( 44 t �� <br /> Well Address : Notal Depth : <br /> WP # q52157 tq (,, Well # : Drilling Rig Type : <br /> Soil Boring# : '; (� � � 5 5�a , Min 2 „ Annular EHD Seal Verified : ElYes ❑ No <br /> Drilling Company : <br /> Driller Onsite : t a � � Screen Length From : To : <br /> Consultant , . /176, c � � <br /> Filter Pack From : To : <br /> Geologist : �K c� lftvt/�t t jam,. Pk 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 El No casing <br /> If yes , location and distance : height <br /> r <br /> SAMPLING ABQVE-GRLXJND <br /> Holding Temperature : 'CONPL.EtiON COMPLEMN <br /> Method : �'""dS'�'� <br /> Of <br /> Screening Method : or«A <br /> Verified Chain of Custody : ❑ Yes El No ft' <br /> ft. <br /> INNIENNOMP <br /> ft. <br /> SPOILS — <br /> Contamination Noted : ❑ Yes ❑ No a� m <br /> K <br /> If yes , spoils storage Location : <br /> soon x _ <br /> Covered : ❑ Yes ❑ No <br /> — ons <br /> If yes , material : ` —' <br /> x <br /> GROUTING or DESTRUCTION Total Depth . 4� ` <br /> Depth to Water : <br /> Grout Material : � �� (�t, }`vvfi <br /> Gallons of Grout Used : �- � v , Uj. MATERIALS/ DEVELOPMENT <br /> Casing Type : <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> ❑ Boring Installation or ng Destruction Slot Size : <br /> Bags of Cement : <br /> METHOD USED Bags Sand /Gravel : <br /> Type/ Brand of Bentonite : <br /> ❑ Pressure Grout ❑ Over Drill Filter Pack Type/Size : <br /> ❑ Gravity Tremie ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 941b <br /> allons Bas qa1lons Bags <br /> Thickest Th<nest 9Ba4s Thickest Thinnest # Bags Bentonite/Cement Mix 3 % Mix 5 % Mix <br /> 2. 5 s 1/ 5 10 1 Bentonite per 47 Ib 1 .41 2 .47 <br /> s 4ro 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 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 F 209 464- 0138 www . sicehd . com <br />