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SAN:JOAQUIN Environmental Health Department <br /> i —COUNTY-- <br /> �. ., GreULneis grouts here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1 inspector: aaliv%0 CONSTRUCTION <br /> Facility Address: 5-700 Wone b— i <br /> Well Address: Total Depth: <br /> WP# Well#:_syE-1 Drilling Rig Type: <br /> Min 2"Annular EHD Seal Verified: ❑Yes []No <br /> Drilling Company: CUnQq <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: lACOIO Filter Pack From: To: <br /> Geologist: 14f VIA Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes,location and distance: 37 <br /> height <br /> SAMPLING ABOVE-GROUND <br /> CowFLECION War <br /> Holding Temperature: cOMPLEotyiPt.Et'1oN <br /> Method: G=na S"rf"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> SPOILS — <br /> Contamination Noted: ❑Yes ❑No r' — <br /> If yes,spoils storage Location: .10xad <br /> &*clan = � <br /> Covered: ❑Yes ❑No <br /> If yes,material: <br /> T _ <br /> GROUTING or DESTRUCTION Total Depth: 45 45� '50 2e <br /> Depth to Water: dr H <br /> Grout Material: recaf <br /> _ MATERIALSIDEVELOPMENT <br /> Gallons of Grout Used: o 0 J. Casing Type: <br /> ❑Well Installation ❑Well Destruction 3g� ) z•s1� Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slat Size: <br /> Boring Destruction g `• 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 ❑Tremie ❑Other: Type of Method: <br /> Water Cement471b Water Cement941b <br /> all Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 50A Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.621 4.7 <br /> 7,5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 s zs so s <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 60 8 <br /> 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 />