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SAN JOAQUIN Environmental Health Department <br /> ---COUNTY-- <br /> ` ., vreu[nc:i yiows I�crr.. <br /> Moonnito�r�ing Well/Soil Boring Inspection Report h�5 <br /> Date: 6 ZS Inspector: y I-kr�CJ--5 CONSTRUCTION <br /> Facility Address: ID00 U0• fl04-Dr: <br /> Well Address: 14 Total Depth: <br /> WP# Lo p2 Well#: Drilling Rig Type: <br /> Soil Boring#: C� + N� 2 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: C <br /> Driller Onsite: � Screen Length From: To: <br /> 2 Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes,location and distance: height <br /> 37 <br /> SAMPLING AWVE-4�AouND <br /> C7iMM-BOX <br /> Holding Temperature: CctwLEr;cN COMPt.Er1ON <br /> Method: Ground Surf."-* <br /> Screening Method: 1111 <br /> groat <br /> Verified Chain of Custody: ❑Yes ❑No ft. <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No ` = r <br /> If yes,spoils storage Location: Stoned <br /> sacjon y <br /> Covered: ❑Yes ❑No <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: r�� I <br /> Depth to Water: a- g% ft• — n <br /> Grout Material: ec,J Geyvp-✓Li- <br /> Gallons of Grout Used: ti MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation�K Slot Size: <br /> oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity �Z-Tremie ❑Other: Type of Method: <br /> Water C ent 471b Water Cement 941b <br /> allons Bags allons Bags <br /> Thickest Thinnest ags Thickest Thinnest kBags Bentonite/Cement Mix 3%Mix 5%Mlx <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.4111 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2 R91 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 10 1 4 20 40 4 <br /> 12.5 25 5 25 s0 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 1 Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />