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$ANJOAQUIN Environmerr.al Health Department <br /> —COUNTY— <br /> �sclvop,+" Greatness groves here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7-tu,ey Inspector: A0644+ CONSTRUCTION <br /> Facility Address: S�%e zval.rbfr 54.l Ave <br /> Well Address: Total Depth: <br /> WP# h Well#: Drilling Rig Type: <br /> Soil Boring#: P /0 S Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: 6441t e Screen Length From: To: <br /> Driller Onsite: D Filter Pack From: To: <br /> Consultant: 441ets Bentonite From: To: <br /> Geologist: TG" <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: height <br /> SAMPLING A80VE.C'nIXJND crtRMN-Box <br /> H OOWLETION COMPtEION <br /> Holding Temperature: <br /> Ground setae. --� —� <br /> Method: grout <br /> Screening Method: <br /> Verified Chain of Custody: ❑ Yes ONO tt, <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No <br /> • s <br /> If yes, spoils storage Location: slattad = $ <br /> aaccrn = <br /> Covered: ❑Yes ONO = 7-4 Paaa <br /> If yes, material: <br /> tt <br /> GROUTING or DESTRUCTION Total Depth: / <br /> Depth to Water: A�''r n' <br /> Grout Material: JAVI Pam- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: -!A �7:u� Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ��// Slot Size: <br /> ❑Boring Installation L76oring 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 RO Tremle ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Bags <br /> s Bags _ <br /> Thickest Thinnest #Bags Thinnest #Bags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 2.s 5 1 10 1 Bentonite per47lb 1.41 5 10 2 20 z Bentonite per 94 Ib 2.82 477.5 15 3 30 310 20 4 40 4 <br /> 12.5 25 5 50 5 <br /> 15 30 6 60 6 <br /> 17.5 35 7 7n 7 <br /> 20 40 8 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 />