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0�a\ ,SMJOAQUIN <br /> I .rsi &', —COUNTY— Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z 2 Inspector: 1 CONSTRUCTION <br /> Facility Address: W. Li AtYJ <br /> Well Address: Total Depth: 1 �` �i0a 5 <br /> WP# Well#: Drilling Rig Type: / t at <br /> Soil Boring#: VA Min 2"Annular EHD Seal Verified: ■Yes ■N• I I i <br /> Drilling Company: Pff Screen Length From: To: <br /> Driller Onsite: <br /> Filter Pack From: To: <br /> Consultant: �i r ; pry f 4i <br /> Geologist:_ TAhYt.ul fte Bentonite From: To: S <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box l I v1 7 _ <br /> Domestic Well Onsite: ❑Yes ❑No casIng . <br /> If yes, location and distance: height J <br /> SAMPLING A00WILFTIO a� <br /> Holding Temperature: coNaLEn°ty c�aur�ir:`ri�orxi <br /> Method: Orosina Surfa4s (J p <br /> Screening Method: oront ( ( O <br /> Verified Chain of Custody: ❑Yes ❑Nott.tt. <br /> SPOILS .� 6 <br /> Contamination Noted: ❑Yes ❑No ,, c <br /> 16 <br /> If yes,spoils storage Location: <br /> Covered: ❑Yes ❑No _ arvw� � <br /> If yes,material: _ � <br /> GROUTING.or-DESTRUCTION Total Depth:-_{ +.. _ . <br /> Depth to Water: WtP—r " ' tt. <br /> Grout Material: P, CeMt <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED D Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill per A w Type/Brand <br /> ' Filter Pack Typp Bentonite:e/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water C16ant 471 Water Cement941b <br /> gallons Bags gallons Bags <br /> Thickest Thinnest 0 Thickest Thinnest Bags BentonitelGemen t Mix 3%Mix 5% Mix <br /> 2.5 s 1 s 10 1 jBiantonits per47lb 1.41 2.47 <br /> s 20 z V i 20 a Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 1s 80 3 <br /> SB 20 4 YU 20 48 4 <br /> 12.5 25 5 1 25 50 5 <br /> 15 80 6 ✓ s0 60 6 <br /> 17.5 85 7 as 70 7 <br /> 20 40 8 AO Be 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />