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SAN.,JOAQUIN Environmental Health Department <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �V ° Inspector: A. CONSTRUCTION <br /> Facility Address: NQnr Nord S 5h0()VPr5 <br /> Well Address: yromSIZ' CarifhTotal Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: GnYCS 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: height <br /> SAMPLING ABaOVS-dROUrtn <br /> Holding Temperature: 00?aOLErION r� X oM ori <br /> Method: C3ra5rya sutacs <br /> Screening Method: groW <br /> Verified Chain of Custody: ❑ Yes ❑No • <br /> tt. tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: <br /> atosta i s <br /> 1lZ�Ofl cE � '$ <br /> Covered: ❑Yes ❑No <br /> = QravatPack <br /> If yes, material: <br /> GROUTING-or-DESTRUCTION. Total De th:Ab..- <br /> Depth to Water: 1�•95� —rts771 � t<. <br /> Grout Material: <br /> Gallons of Grout Used: Jr `. A MATERIALS DEVELOPMENT <br /> jI— '� Casing Type: <br /> ❑Well Installation ❑Well Destruction y��r• k Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring InstallationXBoring Destruction 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 XTremie ❑Other: Type of Method: <br /> Water 96ment 471 Water Cement 941h <br /> allons Rallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 4Bags Benton ltelCement Mix 30/. Mix Sofa 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 Ib 2.82 4.7 <br /> 7.5 15 3 15 <br /> 10 20 4 20 40 4 <br /> 12,5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 1715 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Nazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />