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SAN J OAQ U I N Environmental Health Department <br /> —COUNTY— <br /> ?` Greatness grows her,. <br /> .�r <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:3 q Inspector: ZC> EVIG G1V0I"q0 CONSTRUCTION <br /> Facility Address: �j�'rj �. Muhf- M, <br /> Well Address: XnCXt 1'N Total Depth: <br /> WP# Z�f�� Well#: -et Drilling Rig Type: <br /> Soil Boring#: COIN Min 2" Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: I% ) LQno <br /> Screen Length From: To: <br /> Driller Onsite: sar>) tG -fin ni,, �Z Team,jJ Filter Pack From: To: <br /> Consultant: �ON Up OYYI`IS <br /> Bentonite From: To: <br /> Geologist: <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 /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: Co&FLETION GCOWLELEMN <br /> Method: Ground Surface <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> ft. <br /> ft. <br /> SPOILS = <br /> ;. — <br /> Contamination Noted: ❑ Yes ❑No -' <br /> If yes,spoils storage Location: stonQd = <br /> a+c.on — <br /> Covered: ❑ Yes ❑No = 9 P.-k <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: �/ R - <br /> Depth to Water: W day-) n• n' <br /> Grout Material: PCo- G4M'W� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 15V -;BN Oht nr <br /> Casing Type: <br /> ❑Well Installation /,1Nell 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 /> ressure Grout ❑Over Drill f <br /> eC4-n <br /> Filter Pack Type/Size: <br /> ❑ Gravity �.Tremie 7*ther: Vt KOh Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 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 l P L PI'E9vt re G r-D LAI df,6 vrvc/tj 0 h <br /> 12.5 25 5 25 50 5 5� <br /> 15 30 6 30 60 6 �{�tt n <br /> 17.5 40 8 40 80 AS-�{ M W 12 , r/I V�J `� t`}S 3, V W 3, PetP. <br /> P�I Cbz St�IIIOW I fps 2 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />