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Cz� <br /> s SAN JOAQUIN Environmental Health Department <br /> " 3 <br /> COUNTY <br /> ung P Greatnr � s grows peri . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : Inspector : a� i CONSTRUCTION <br /> Facility Address : alS 1 � `J <br /> Well Address : Vv (Ct q , ( � , Total Depth : <br /> WP #�) �j '� '� �� Well # : Drilling Rig Type . <br /> Soil Boring# : 0. r 610 Min 2 " Annular EHD Seal Verified : ❑ Yes El No <br /> Drilling Company : arv.,Core <br /> Screen Length From : To : <br /> Driller Onsite : <br /> Consultant : �' ( , � => � L Filter Pack From : To : <br /> Geologist : � 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 ❑ No casing <br /> If yes , location and distance : height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature . coiMPLEtIoN COMPLETION <br /> Method : G=nd S` wf2c* <br /> Screening Method : otO <br /> Verified Chain of Custody : ❑ Yes El No ft* <br /> ft. <br /> ft. � p <br /> SPOILS <br /> V'. <br /> Contamination Noted : ❑ Yes ❑ No r <br /> - C <br /> If yes , spoils storage Location : . bid <br /> aacton <br /> Covered : ❑ Yes ❑ No <br /> s�� I <br /> If yes , material . <br /> GROUTING or DESTRUCTION Total Depth : <br /> Depth to Water : ^� 1S <br /> Grout Material : NtefKA (? f%Ae . . <br /> Gallons of Grout Used : 10 oa MATERIALS / DEVELOPMENT <br /> Casing Type . <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> ❑ Boring Installation ❑ Boring 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 ❑ Tremie ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest # Bags Bentonite/Cement Mix 3 % Mix 5 % Mix <br /> 15 5 1 1101 5 10 1 Bentonite per 47 Ib 1 .41 2 .47 <br /> 5 10 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 Stockton , California 95205 1 T 209 468 - 3420 F 209 464- 0138 www . sicehd . com <br />