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SANS=JOAQUIN _Environmelal Health Department <br /> .—COUNTY— <br /> Greatness grows here. <br /> �titjFAP`a. <br /> Monitorin Well/Soil Boring Inspection Report <br /> Date: <br /> d\ Inspector: CONSTRUCTION <br /> � <br /> Facility Address: Q�`^.n ^ �\-N-U Total Depth: <br /> Well Address: <br /> WP# \\hQ — 11� �S tb Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: r �` r �� Screen Length From: To: <br /> Driller Onsite: l�\�� Filter Pack From: To: <br /> Consultant: �« ���1`�— Bentonite From: To: <br /> Geologist: 1�r�— � Grout From: To: <br /> Public Water System Onsite: WYes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes i�No casing <br /> height <br /> If yes,location and distance: <br /> ABOVE-GROUND IV <br /> SAMPLING OO&FLErION COMPLETION <br /> Holding Temperature: Gawnd so us—i—� <br /> Method: grout <br /> Screening Method: ..n• <br /> Verified Chain of custody: ❑Yes ❑No n• _ <br /> SPOILS = <br /> r = ^ <br /> Contamination Noted: El Yes No R• N.. a <br /> �\ <br /> -if�tea,spoils storage Location $IOC°° = 3 <br /> aw�on ;�y <br /> Covered: Yes ❑No gravaIPac` <br /> If yes, material: ��� � < <" ���-(>✓L <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 9-,)' �Q <br /> Grout Material: tv(iA t � MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 6�N' Nwg 0 o`� — Casing Type: <br /> Blank Feet Screen Feet <br /> ❑Welllnstallation WeIlDestruction Slot Size: <br /> El Boring Installation El <br /> lllBBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> t Type/Brand of Bentonite: <br /> ❑Pressure Grout L`Uover Drill Filter Pack Type/Size: <br /> V� Type of Method: <br /> ❑ Gravity �Tremie ❑Other: <br /> Water Cement 471b Water Cement941b <br /> Ilons Be <br /> Bes <br /> allons #Bags BentonitelCement Mix 3o/a Mlx 5a/a Mix <br /> Thickest Thinnest #Bags Thickest Thinnest Benlon0e per4i to 1.41 2.47 <br /> 2.5 5 1 5 10 1 2.62 4.7 <br /> 5 10 2 10 20 2 Bentonite per 94 to <br /> 3 15 30 3 <br /> 10 15 20 0 20 40 4 <br /> 12.5 2 5 25 50 5 <br /> 30 60 6 <br /> 1 3 35 70 7 <br /> 17. 35 715 90 B0 0 <br /> 20 40 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.co <br />