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�< SAN JOAQUIN Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7i Inspector:cS'(�p�►,�►ru/�/(S1,rSG( CONSTRUCTION <br /> Facility Address: jq V4 W. CIr Pier' � mv�--1 6 <br /> Well Address: �)'D(�'.�1n Total Depth: <br /> WP#_2'G(9& (o3 Well#: II <br /> M1�—�1 C- Drilling Rig Type: Io <br /> Soil Boring#: <br /> Drilling Company: P r1ea" Min 2"Annular EHD Seal erified: KYes ❑No <br /> �2+ <br /> Driller Onsite: Screen Length From: To:�_ <br /> Consultant: �'] Filter Pack From: To: <br /> Geologist: J�C�{�j�-�e,�� Bentonite From: 1,111 To:� <br /> Grout From: To: <br /> Public Water System Onsite: El Yes El No COMPLETION ❑ Stove Pipe ,hristie Box <br /> Domestic Well Onsite: El Yes ❑No <br /> casing <br /> If yes, location and distance: height <br /> . <br /> SAMPLING T <br /> ABOVE-GROUND TY 80X <br /> Holding Temperature: COWL1ON CH GtiA15RIS EnO�V <br /> Method: Ground sxn>r. <br /> Screening Method: + <br /> o <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> SPOILS it. <br /> tt. <br /> Contamination Noted: ❑ Yes El No = <br /> If yes,spoils storage Location: slatted <br /> aeon F <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> x• <br /> GROUTING or DESTRUCTION Total Depth:_(irDIA fD 1 IF <br /> =_ <br /> Depth to Water: �0-111 tt• — tt- <br /> Grout Material: r 6703 `MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: (tiDIVIS Casing Type: <br /> Nell Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> 321ravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Ba s gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest Bags Bentonite/Cement Mix 3% MIX 5%MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 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 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />