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SA N J OAQ U I N Environmental Health Department <br /> u , - -- COU NTY ---- <br /> Greatness grams heril . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date , 23 Inspector : J c,, A Is CONSTRUCTION <br /> Facility Address : 40j - 14h S <br /> Well Address : Total Depth : <br /> WP # 00 91 f 6 Well # : mW- 6 Drilling Rig Type : <br /> Soil Boring # : Min 2 " Annular EHD Seal Verified : 11 Yes No <br /> Drilling Company : � e.o✓ e- <br /> Driller Onsite : III - Screen Length From : To : <br /> Consultant : P� L Filter Pack From : To : <br /> Geologist : 61*00004n Bentonite From : To : <br /> Grout From : To : <br /> Public Water System Onsite : ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes El No casing <br /> If yes, location and distance : height <br /> T <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature : COMPLETION CC16IT ETION <br /> Method : Grwnd sLrtaca ._.. <br /> Screening Method : arm <br /> Verified Chain of Custody : ❑ Yes El No ft - <br /> ft . <br /> ft . <br /> SPOILS — <br /> Contamination Noted : ❑ Yes ❑ No CD <br /> C <br /> If yes , spoils storage Location : — <br /> stotc$d � <br /> ago n <br /> Covered : ❑ Yes ❑ No <br /> 7AV'w Pack <br /> If yes , material : ` <br /> V - <br /> GROUTING or DESTRUCTION Total Depth : _ <br /> Depth to Water : _ 1 � ft• ft • <br /> Grout Material : WA <br /> Gallons of Grout Used : ?— q �` MATERIALS / DEVELOPMENT <br /> Casing Type : <br /> ❑ Well Installation Well Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> ❑ Boring Installation ❑ Boring Destruction Bags iz Cement : <br /> METHOD USED Bags Sand / Gravel , <br /> Type/ Brand of Bentonite : <br /> El Pressure Grout ``yOver Drill Filter Pack Type/Size : <br /> ❑ Gravity 11 remie ❑ Other : Type of Method : <br /> Water Clement 471b Water Cement 941b <br /> Jallons Bags gallons Bags <br /> Ln <br /> Thickest Thinnest nBags Thickest Thinnest # Bags Bentonite/Cement Mix 3 % Mix 5 % MIX <br /> 2. 5 5 1 5 10 1 Bentonite per 47 Ib 1 .41 2047 <br /> 5 10 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 � 40 RO S <br /> Q , � 10/ 16 / 2017 <br /> 1868 E . Hazelton Avenue 1 tockton , California 95205 1 T 209 468 - 3420 1 F 209464,-, 0138 www . sicehd . com <br />