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SANsJOAQUIN <br /> r (( Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring <br /> ,4Well/Soil Boring Inspection Report <br /> Date: 2 �� 20 Inspector: `�'"`^ "" ` d CONSTRUCTION �v ' 122,i23" 15•S� <br /> Facility Address: 0 S ' -tp )li 1 <br /> Well Address: Total Depth: <br /> WP# 0 0 g o s 0 We Drilling Rig Type: <br /> Soil Boring#: S V — 12 cSV'12� e In 2"Annular EHD Seal Verified: ElYes ONO <br /> Drilling Compan . C 61SCOd <br /> � <br /> Driller Onsite: O SK l Jreen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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 —r cae ing <br /> If yes, location and distance: II height <br /> SAMPLING ABOVE-GROUND C418m .-aoX Nto•-k,�xx <br /> Holding Temperature: COh1PLEr10N COMPLETION C � <br /> Method: Ground S"t"' 3 <br /> Screening Method: g(out <br /> Verified Chain of Custody: ❑ Yes ONO I ft - S y <br /> SPOILS tt <br /> Contamination Noted: ❑ Yes ❑No r° <br /> If yes,spoils storage Location: alO1tad <br /> aeon <br /> Covered: ❑Yes ONO = <br /> grave pact 14. 6 <br /> If yes, material: <br /> ,ROUTI or DESTRUCTION Total Depth: 3 _ S"rA <br /> Depth to Water: <br /> Grout Material: tAt- (N MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> 1 Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> 11 Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of 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 Cement 471bE20 <br /> er Cement 941b <br /> allons Bagsns Bags <br /> Thickest Thinnest k Bags Thinnest k Bags Ben�erlltelremenl:MIX 3% MIX 5%MIX <br /> 2.5 5 1 10 1 Bentonite per 47 lb 1.41 2.47 _ <br /> s 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 30 3 - i- <br /> 30 20 4 40 4 <br /> 12.5 25 5 50 5 <br /> 1s 30 6 60 6 <br /> 17.5 35 7 20 40 0 80 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 />