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1 <br /> '°"`c°` SA6JOAQUIN' I Environmental Health Department <br /> ,iU'-y1� —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 9 Inspector: w�JF�" CONSTRUCTION 5✓� /� <br /> Facility Address: lad TyaeP�f^� �'+� <br /> Well Address: Total Depth: <br /> Wpp t,7 p�o7 Well#: ✓P/o�S/�/Oj Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: jy24!P= <br /> Screen Length From: To: <br /> Driller Onsite: Dle 0 Filter Pack From: To: <br /> Consultant: Bentonite From: To: <br /> Geologist: 74" Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> height <br /> If yes,location and distance: <br /> SAMPLING ABOVE-Ga0UN0 CHAtm4y ox <br /> co&FLETION COMPLEnON <br /> Holding Temperature: o a nd s,tW41 <br /> Method: grout <br /> Screening Method: <br /> Verified Chain of Custody: ❑ Yes ❑No n. <br /> SPOILS a <br /> Contamination Noted: ❑ Yes ❑No <br /> s z/SI <br /> If yes,spoils storage Location: r a trod S' c B Ln9-�'1y <br /> O fortes on <br /> Covered: ❑ Yes ❑No _ aaVatParx <br /> If yes,material: yr {U z r X JI <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: -V-" e*e"{ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 2 JIB!A Casing Type: <br /> [ ell Installation ❑Well 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 /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie Other: Fns �� Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Ba s allons Ba s <br /> Thickest Thinnest pBags 7m&est 7hmnest uBags _ BentonitelCement Mix 3°/a Mix Vya Mix_ <br /> 2.5 5 1 5 10 1 Bentonite per 41 ID 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94Ib 2.82 4.1 <br /> 15 3 15 30 3 <br /> 10 - <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 15 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 135 7 35 70 7 <br /> 20 4o a 40 80 a 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />