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"1 , SANaJOAQUIN <br /> �o Environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2-2A-20 Inspector: CONSTRUCTION <br /> Facility Address: t!• Ce * t / 116e O� <br /> Well Address: Total Depth: <br /> WP# Well#: W-Q '41-CJ/ Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ONO <br /> Drilling Company: ^��5 Screen Length From: To: <br /> Driller Onsite: `_7 <br /> Consultant: 7� W4 a �:�c� rvAc �R6 Filter Pack From: To: <br /> Geologist: Rr76 /)a✓iJ Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: height <br /> —QW7;F <br /> SAMPLING ABovE-GROUND y w <br /> COWLETION C.HRIs -aox Ar✓s <br /> Holding Temperature: COMP1.ETIoN <br /> Method: Ground Sudan T� <br /> Screening Method: <br /> Verified Chain of Custody: ❑ Yes ONO —e.X Zi , <br /> SPOILS <br /> Contamination Noted: ❑ Yes ONO u r <br /> If yes,spoils storage Location: 4wnad _ s 3 <br /> Covered: ❑Yes ONO �sctlen y, ,l Ale ID f sof <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: _ • S <br /> Depth to Water:/IF ft. <br /> Grout Material: A)ey-r< emrew71 <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation [9161ell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity CKremie ❑Other: Type of Method: <br /> Water t471b Water Cement 941b <br /> allons ctc! gallons Bags <br /> Thickest I Thinnest It Bags Thickest I Thinnest 48ags Bentonite/Cennent Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 1510 20 4 20 <br /> 30 3 - J •/ J L <br /> 12.5 25 5 25Is 30 6 so <br /> 50 s �Yl•yC/� tj 3 Q'^/��/36—/y�Qf/�F�a✓ �o�s y7lkt�pa�w.� <br /> 17.5 35 7 35 /S <br /> 20 40 B 40 BO B y7/4J <br /> 3A 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 />