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SAN JOAQUIN Environmental Health Department <br /> ---- COUNTY <br /> Greutn "e s aro ;vs here . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : Inspector : AZNt CONSTRUCTION <br /> Facility Address : 0 k <br /> Well Address : � NC C41 Total Depth : <br /> WP # o o 10 :5 . Well # : Drilling Rig Type . <br /> Soil Boring# : 61 MIC O 61 Min 2 " Annular EHD Seal Verified : ❑ Yes [] No <br /> Drilling Company : T ryko <br /> Screen Length From : To : <br /> Driller Onsite : <br /> Consultant : V Filter Pack From : To : <br /> Geologist : lsofr - . 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 /> AD W� <br /> SAMPLING ABOVS-GROUND <br /> Holding Temperature : COtv' ' LETION COMPLETION <br /> Method : Ground SLalacs of <br /> Screening Method . or«n <br /> Verified Chain of Custody : ❑ Yes El No <br /> ft. <br /> ft. loss <br /> SPOILS : =_ <br /> Contamination Noted : ❑ Yes ❑ No _ <br /> If yes , spoils storage Location : ataned ._ <br /> v- <br /> a�c;ion �• <br /> Covered : ❑ Yes El No — <br /> = Fret pag* <br /> If yes , material : <br /> GROUTING or DESTRUCTION Total Depth : STT . _ <br /> Depth to Water : ^� I LA ft' <br /> Grout Material . NQm�� COVWVU\� <br /> Gallons of Grout Used : � — � MATERIALS / DEVELOPMENT <br /> bcw�rV111avCrwC0.5 ing Type : <br /> ❑ Well Installation ❑ Well Destruction vAr� P� Blank Feet Screen Feet <br /> 2� Slot t • Slot Size : <br /> El Boring Installation D Boring Destruction 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 /> ElGravity QTremie ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Fallons Bags <br /> Thickest Thinnest # Bags Thickest Thinnest 41Bags Bentonite/Cement Mix 3 % MIX 5 % Mix <br /> 2. 5 5 ✓ 1 Z 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 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 T 209 468 - 3420 F 209 464- 0138 www . sicehd . com <br />