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SAN J OAQ U I N Environmental Health Department <br /> �. COUNTY p <br /> GreO tlleS5 <br /> _ q ; ows here . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date@ 3 2Z3 ' 21 Inspector : �"� CONSTRUCTION <br /> Facility Address : gdxr aK °o <br /> Well Address : Total Depth : <br /> WP # tyot,/i7</ Well # : Drilling Rig Type : <br /> Soil Boring# : �R ° 711 / Z,� Min 2 " Annular EHD Seal Verified : El Yes ❑ No <br /> Drilling Company : Cc depeele <br /> Driller Onsite : vt 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 A 30VE-sGRUYJND <br /> Holding Temperature : coWLEt' j° ra COMPLETION <br /> Method , °tc""� S"� ' '�—' <br /> Screening Method : arm <br /> Verified Chain of Custody : ❑ Yes El No mmssent ft. <br /> ft. <br /> SPOILS <br /> 0 <br /> Contamination Noted : El Yes ❑ No ? CD <br /> If yes , spoils storage Location : <br /> siottad <br /> soon =r= — <br /> Covered : ❑ Yes ❑ NognV64 Pack <br /> = . <br /> If yes , material : _ <br /> GROUTING or DESTRUCTION Total Depth : 145 " <br /> Depth to Water : /D ft• <br /> Grout Material : � �� w <br /> S� MATERIALS / DEVELOPMENT <br /> Gallons of Grout Used : <br /> Casing Type : <br /> ❑ Well Installation ❑lWell Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> ❑ Boring Installation LJ Boring Destruction <br /> Bags of Cement : <br /> METHOD USED Bags Sand / Gravel : <br /> Type/ Brand of Bentonite : <br /> ❑ Pressure Grout ❑ Over Drill <br /> � Filter Pack Type/Size : <br /> El Gravity RTremie ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest # Bags Bentonite/Cement Mix 3 % MIC rJ' % Mix <br /> 15 5 1 5 10 1 Bentonite per 47 Ib 1 .41 2 .47 <br /> 5 10 2 io 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 /> 115 25 5 25 50 5 Ly�1 ;' �y '000 <br /> 15 30 6 30 60 6 , V <br /> 17. 5 35 1 7 35 70 1 7 � tv � 'Y '4� ., <br /> 20 40 8 40 80 1 8 <br /> 0p� tJ v ' . <br /> ✓ 10/ 16 / 2017 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 F 209 464- 0138 1 www . sicehd . com <br />