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SAN JOAQUIN Environmental Health Department <br /> ---COUNTY--- <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> �� � '�A IV ONSTRUCTION <br /> Date. Inspector. / <br /> Facility Address: -- � � .� �� � N ,��� <br /> S c Lim_ � <br /> Well Address: 010 <br /> Total Depth:'/%-, <br /> WID ( l� Well#: r 1 Drilling g Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Vefi''A: ❑ Yes [I No <br /> Drilling Company: <br /> D _ � _ �� Screen Length From: To: <br /> Driller Onsite: <br /> Filter Pack From: To: <br /> Consultant: <br /> Bentonite From: To: <br /> Geologist: <br /> V 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 zws^ <br /> 7 <br /> 1 -qw-T <br /> SAMPLING ��1� s; AJVE-GROUND <br /> COMPLETION GHRSSTY-80X <br /> Holding Temperature: COMPLETION <br /> Method: <br /> Ground sLjrl=v <br /> Screening Method: rf+t�s• ��� afoot <br /> s ❑N o � — <br /> Verified Chain of Custody: 1 El Ye <br /> �� � � �r s e <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No = m <br /> wr — <br /> If yes, spoils storage Location: stoctad y <br /> a*c;ton r= <br /> Covered: ❑ Yes ❑No w Qrayst pack <br /> If yes, material: , <br /> GROUTING or DESTRUCTION Total D pth:��� <br /> Depth to Water: j <br /> Grout Material: C MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation ��o <br /> ring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity Nfremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 1 s 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 30 3 <br /> 10 20 4 40 4 <br /> 12.5 25 5 50 5 <br /> 15 30 4�AR401 <br /> 60 6 <br /> 17.5 35 70 7 <br /> 20 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.corn <br />