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SAN IOAQUIN Environmets_dl Health Department <br /> —COUNTY— <br /> _ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: kIlLM . inspector: CONSTRUCTION <br /> Facility Address: lea tv ��+J�N Total Depth: <br /> Well Address: <br /> WP# il��p�Lt Well#:&.�SV� Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑Yes ONO <br /> Drilling Company: P d\St-W6 — S?a ' Screen Length From: To: <br /> Driller Onsite: �� � Filter Pack From: To: <br /> Consultant: RC Bentonite From: To <br /> Geologist: SO`.y 1^ "Y Grout From: To: <br /> Public Water System Onsite: kYes lE]No COMPLETION El stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑\Yes No height <br /> height . <br /> If yes,location and distance: <br /> SAMPLING �Cowil MOONO COMPLETION <br /> Holding Temperature: Gwind surf c <br /> Method: grout <br /> Screening Method: k_ft. <br /> Verified Chain of Custody: El Yes ❑No tt <br /> SPOILS <br /> Contamination Noted: ❑Yes Noited <br /> • = o <br /> { ysc e4sstorageLocation: �!\SLst +b <br /> ey = E <br /> , N�'i0n ry — <br /> Covered: W,Yes ❑No OIP� <br /> If yes, material: Sr`t Fes- <br /> GROUTING or DESTRUCTION Total Depth: )'O <br /> Depth to Water: •S5- kSd P6s t <br /> Grout Material: 0A&S tr__w SIC r MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: r �0 iti\ ^ Casing Type: <br /> Blank Feet Screen Feet <br /> ❑Well Installation (I�IWeII Destruction Slot Size: <br /> []Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> El Pressure Grout tsfOver Drill Filter Pack Type/Size: <br /> k o, Type of Method: <br /> ❑ Gravity Tremie ❑Other: <br /> Water cement 47lb Water Cement 941b <br /> Be s allons Be s <br /> allons #Bags _BentonitelCement Mlx 3%Mix 5%Mix <br /> Thickest Thinnest #Bags Thickest Thtonest 1.41 2.47 <br /> 1 1 Bentonite per 471b <br /> 45 5 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 5 10 30 3 <br /> 7.5 15 3 15 <br /> 10 20 4 20 40 4 <br /> 5 25 50 5 <br /> 12.5 30 60 6 <br /> 15 0 1 35 70 7 <br /> 20 7 <br /> 20 40 s 40 so s 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95206 1 T 209 468-3420 1 F 209 464-0138 1 www sicehd.com <br />