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SAN J O A Q U I N Environmental Health Department <br /> ---- C O U N T Y ----- <br /> `'" '� Greatness grows here . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : l St inspectors <br /> Facility Address :A S �. . <br /> Well Address — moor Total Depth : <br /> WP # o Well # . Drilling Rig Type : <br /> Soil Boring# : � �. S � � E S Min 2 " Annular EHD Seal Verified : ❑ Yes [I No <br /> Drilling Company : <br /> Driller Onsite : V Screen Length From : To : <br /> Consultant : �( A,AN` ( ,�-�✓` Filter Pack From : To : <br /> 5 Bentonite From : To . <br /> Geologist : � � <br /> Grout From : To . <br /> Public Water System Onsite : ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes ❑ No casing <br /> If yes , location and distance : height <br /> SAMPLING ABOVEGROUND <br /> Holding Temperature : COW' �jON COMPLETION <br /> Methods cdrecnd surixs +__�___`_"_' <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes El No fto <br /> ssss ft. <br /> ft. 100410110101110 <br /> SPOILS .. <br /> 10, <br /> — <br /> f <br /> Contamination Noted : ❑ Yes ❑ No a� = <br /> If yes , spoils storage Location : ,- 1 > yr <br /> stoma <br /> Covered : El Yes El No <br /> 5 r' � �_( �� s — <br /> If yes , material : <br /> � ,2 — <br /> c �� <br /> -- ---GROUTING -or - DESTRUCTION Total Depth :-T5 <br /> Depth to Water : i n- *" ft• <br /> Grout Material : � <br /> Gallons of Grout Used : _MATERIALS/ DEVELOPMENT <br /> -ti � �� Casing Type : <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> ❑ Boring Installation C'_ oring Destruction 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 65remie ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest # Bags Thickest Thinnest Bags Bentonite/Cement 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 2 . 82 4 . 7 <br /> 7. 5 1 15 3 15 1 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 /> 35 �Z 35 70 7 <br /> 2 40 8 40 80 8 <br /> 10/ 16/2017 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 F 209 464- 0138 www . sicehd . com <br />