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SAN JOAQUIN Environmental Health Department <br /> --COUNTY— <br /> , Greatness groves here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: inspector: A.L-&i I _ CONSTRUCTION <br /> Facility Address: U/0c, sN'(6 cwj. V44,1 <br /> Weil Address: Total Depth: <br /> WP# Igco16A Well#: Drilling Rig Type: <br /> Soil Boring#: G w-OL Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 9eo ecrwr <br /> Driller Onsite: Tara t Screen Length From: To: <br /> Consultant: 9w'5cu5 Filter Pack From: To: <br /> Geologist: A Loom Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No � casing <br /> If yes, location and distance: height � <br /> SAMPLING ABOVE-GacuND <br /> COLPLE ION c <br /> Holding Temperature: comPLEnoNoMplEnoN <br /> Method: Oro ndS 1ai 7 — <br /> Screening Method: gran <br /> Verified Chain of Custody: El Yes ❑No tl• <br /> n. <br /> SPOILS71 <br /> = <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes,spoils storage Location: � <br /> s ' <br /> o _ $ <br /> aclon <br /> Covered: ❑ Yes []No — gravol <br /> If yes, material: �]j _= <br /> Pack <br /> GROUTING or DESTRUCTION Total Depth: 6eII <br /> Depth to Water: <br /> Grout Material: VIeWL <br /> Gallons of Grout Used: \� t9uus MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well 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 /> ❑ Gravity If remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags eallons Ba s _ <br /> Thickest Thinnest aeags Thickest Thinnest neags Bentonite/Cement Mix 3%MIX 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> . 20 2 io 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 i <br /> 30 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 />