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SANJOAQUIN <br /> Environmental Health Department <br /> —COUNTY— <br /> , Grrutness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:R06r7.d Inspector: 1h•I.41AIA, CONSTRUCTION <br /> Facility Address: ZWO Sh�tLei V y <br /> Well Address: Total Depth: <br /> WP# 1400116t1 Well#: Drilling Rig Type: <br /> Soil Boring#: (>Lt/-03 Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: Pevtecrdr, <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: pu�pu�5 Filter Pack From: To: <br /> Geologist: of in Bentonite From: To: <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: neigh(: T. <br /> SAMPLING ABOVE-GROUND T <br /> COMPLETION COE•ION <br /> Holding Temperature: COMPLETION <br /> Method: Grounds t'c• + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Nott• <br /> tt. <br /> SPOILS <br /> a <br /> Contamination Noted: ❑ Yes ONO <br /> If yes,spoils storage Location: .lorcaa ' <br /> orlon _ $ <br /> Covered: El Yes ❑No -- grawvack <br /> If yes, material: <br /> 21, <br /> GROUTING or DESTRUCTION Total Depth: (0 1 <br /> Depth to Water: <br /> Grout Material: O C Pot Pw <br /> Gallons of Grout Used: 0 5 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation �iBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill Filter Pack Type/Size: <br /> ❑ Gravity rqayremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br />-( Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/cement Mix 3e/u MIX 5 MIX <br /> 2.5 5 1 s 10 1 Bentonite per47lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.821 4.7 <br />.i 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 s Ors llr✓5 �ol��gG1jE ticcCA QN""'TSRH <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br />:I 20 40 8 40 80 a �Jfc(GG i N Stvtl ,tc LA IV-CA t t•44D r'PrCU—e <br /> LJocNS L41111 IJI (. 10/16/2017 <br /> { 1868 E. Hazelton Avenue i Stockton, California 96206 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />