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�/ ° = SAN�.J0ANtl+,'' Environmei ! Health Department <br /> 1` rE.G_' —COUNTY <br /> A` Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 4440�9ju'tw Inspector: CONSTRUCTION N/f� <br /> Facility Address: R�1 <br /> Well Address: Total Depth: <br /> Wp# \&,, l Well#: IJ�R Drilling Rig Type: <br /> Soil Boring#: 2,\ - ' Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: I NJ /��sg; - bU� Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: �t� a C lJ��' Bentonite From: To: <br /> Geologist: m V" <br /> Grout From: To: <br /> Public Water System Onsite: 1 Yes ❑No cOMPLETIOWIN❑Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes �No casing <br /> II�1 <br /> If yes, location and distance: � height <br /> SAMPLING ABOVE-GROUND c}wlsrveox <br /> COMPLETION cOMP,ETION <br /> Holding Temperature: _ <br /> M cvovmsutac� <br /> Method: <br /> groutScreening Method: <br /> Verified Chain of Custody: ❑ Yes ❑NoPX <br /> tt. <br /> SPOILS e <br /> Contamination Noted:�� El Yes LINO ' <br /> If yes,spoils storage Location: ,lotted sic .S <br /> sacion <br /> Covered: IkYes ONO QMV Mpees <br /> If yes, material: <br /> GROUTING or ESTRUCTIO Tptal Depth: 5 ' <br /> tt. — tt. <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT i'V)P, <br /> Gallons of Grout Used: �b� Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot size: <br /> El Boring Installation Loring Destruction SOLI, uP\�Oi gags of Cement: <br /> METHOD USED e Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Over Drill Filter Pack Type/Size: <br /> 19 Gravity ❑Tremie ❑Other: Type of Method: <br /> Water 7ement471b Water cement941b <br /> allons Be alien Ba s <br /> Thi es Thinnest #Bags Thickest Thinnest If Bags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 10 20 2 Bentonite per 941b 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> is 3o 6 3o 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 4o s 40 e0 e 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.co <br />