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lolSAN JOAQUIN <br /> Environmental Health Department <br /> I —COUNTY— <br /> _T <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �D—L( t2 Inspector: 14Seem- CONSTRUCTION <br /> Facility Address: /vela' L/_4-3 d9 10112, <br /> Well Address: Total Depth: <br /> WP#006/Z y- Well#:MLOW 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: �S S� Filter Pack From: To: <br /> Geologist: 7 kn -wa Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes El No casing <br /> If yes, location and distance: � height <br /> SAMPLING ABOVE-GROUND <br /> CO&PLETION COMPL'EnON <br /> Holding Temperature: conit+iETioN <br /> Method: Ground sudac0_F_ <br /> Screening Method: grout <br /> Verified Chain of Custody: ElYes ❑No ----n' <br /> —n. <br /> n. <br /> SPOILS mvO 13 A Y = e <br /> Contamination Noted: ❑Yes ❑NornW 1313 c <br /> If yes,spoils storage Location: t:` = s <br /> t M W 1�3 G slotteddB <br /> s�c4on �;, _ <br /> Covered: El Yes ONOgravol Pack <br /> — <br /> If yes,material: <br /> t r ' <br /> GROUTING or DESTRUCTION Tota Depth: /l� _ •. <br /> Depth to Water: A14 R 8. <br /> Grout Material: N <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation jKWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <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 bOremie •Other:�X y�asW Type of Method: <br /> Water Cement 47lb Water Cement941b <br /> allons Bags 2allons Bags <br /> Thickest Thinnest NBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5%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 941b 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 /> 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 />