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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> „ Greatness grows h w. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �1�,� Inspector:� CONSTRUCTION <br /> Facility Address: 2ACVO S LI�Sa„ VLc4 <br /> Well Address: Total Depth: <br /> WP# 0:1,L100l64 Well#: Drilling Rig Type: <br /> Soil Boring#: (,W -02. -Cl� <br /> Drilling Company: p to Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: <br /> �`e Screen Length From: To: <br /> Consultant: a S Filter Pack From: To: <br /> Geologist: A 6.4 C rA.-Z 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: R height <br /> SAMPLING ABOVE-GROUND <br /> COWLETION COMPLEnoN <br /> Holding Temperature; cotitaitTioN <br /> Method: Ground 6 �— <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No tt <br /> tt. <br /> SPOILS _ <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: alonod ` <br /> wrJon <br /> Covered: El Yes ❑No 'I = <br /> I>nwvl Pack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: SGt i <br /> Depth to Water: 7ypvi0 �{ct, ( I tt = tt' <br /> GroutMaterial: V6e&,F ce.- e. 4< MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: HISS caCa I Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ElBoring Installation PfBoring Destruction I <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: i❑ Gravity h[Tremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement941b <br /> allons Bags stations Bags <br /> Thickest Thinnest kBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% MIX 5%MIX <br /> Is 5 i 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 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 /> ZI �,,,,,,�,r ut S e(A 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 />