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SAN JOAQUIN Environmental Health Department <br /> COUNTY . <br /> (.;neatness grows here. <br /> /� Monitoring Well/Soil Boring Inspection Report <br /> Date: � 6 Zo" Inspector: ��11' CONSTRUCTION <br /> Facility Address: ZV16 0 If�aIG yu-j i <br /> Well Address: Total Depth: <br /> WP# OQLL D535 Well#: Drilling Rig Type: Nand ylf <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: SCQd l� Screen Length From: To: <br /> Driller Onsite: pYiUld o/UPtIOr nu <br /> T Filter Pack From: To: <br /> Consultant: v rnrrS <br /> Geologist: t Bentonite From: To: <br /> 4�nf <br /> 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 T <br /> SAMPLING ABOVEGROUND CF6iiM43OX T <br /> Holding Temperature: OOMPLE iON cOMPLEnON <br /> Ground Satan <br /> Method: <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No -�--n; <br /> — <br /> SPOILS <br /> P <br /> Contamination Noted: ❑Yes El No <br /> T = o <br /> If yes,spoils storage Location: ,lend s7 = 3 <br /> soc don <br /> Covered: ❑Yes ❑No = gnvq Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ~ <br /> Grout Material: 7` e MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation 10Boring 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 ❑Tremie ❑Other: Type of Method: <br /> cement 471b Water cement 941b <br /> Baas allons 80 s <br /> s Thickest Thinnest 9Bags Benteniteleement MiX 3% MIX 5%MiX <br /> 1 s 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 3- 15 30 3 <br /> 4 20 40 4 <br /> 5 25 so 5 <br /> 6 30 60 6 <br /> 7 35 70 7 <br /> 209 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.corn <br />