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ally <br /> CIO SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> s�?eivoa��P Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> ^t r <br /> Date: U6 Inspector: S I h6ftntY7 at V0hgSA CONSTRUCTION <br /> Facility Address: l qoy (i• Chg✓4-co 4 Sit c{Gf'b " � <br /> Well Address: Total Depth: 25y_ nII <br /> WP#XOO q(o3 Well#: MW-.SG Drilling Rig Type:_ �10 W ` ��'Yl Yd tG11C <br /> Soil Boring#: A1A <br /> Drilling Company: Min 2"Annular EHD Seal Verified► : �WYes ❑No <br /> p v� �Er1��.(lp-G 1 <br /> Driller Onsite: M'%QV.9A Screen Length From: To: ► <br /> Consultant: C�{pftC Filter Pack From: Zt0 To: a <br /> Geologist: RSi'1L2 Bentonite From: To: S <br /> Grout From: 51 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 ABpVE-GROUND <br /> Holding Temperature: CONFLET10N CCOMPPLET ON <br /> Method: Ground S"ri"c' — <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt• <br /> tt. <br /> tt. <br /> SPOILS <br /> = e <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slatted <br /> apron — � <br /> Covered: ❑ Yes ❑No <br /> ack <br /> If yes, material: =__ <br /> GROUTING or DESTRUCTION Total Depth:__6jVt,5 fVA(X {C4) =_ <br /> Depth to Water: tt• tt' <br /> Grout Material: W? ; .{' i 60 av <br /> Gallons of Grout Used: 2A Lois MATERIALS/DEVELOPMENT <br /> �'-'�T Casing Type: <br /> LW 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 /> �ravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> gall s Bags gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />