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SAN JOAQUIN Environmental Health Department <br /> - COUNTY <br /> Monitoring Well/Soil Boring Inspection Report I <br /> Date: t 'tv( 3 Inspector: l v CONSTRUCTION c/°tl v ��� QcrAXs <br /> Facility Address: l-310 1—• L+tj w An1 � <br /> l <br /> Well Address: Total Depth: <br /> WP# I; Drilling Rig <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: 'Qq Yes []No <br /> Drilling Company: Screen Length From: i To: x <br /> Driller Onsite: 3 s <br /> Filter Pack From:—�— To: \ <br /> Consultant: Bentonite From: S To: r <br /> Geologist: 'Iran^ Grout From: 41' To: U <br /> Public Water System Onsite: ❑Yes 1No COMPLETION ❑ Stove Pipe %Christie Box <br /> Domestic Well Onsite: ❑ Yes No casing <br /> -- ��If yes,location and distance: height <br /> SAMPLING ABOV&SIRICUND ctwlsTve°x <br /> COMPLETION COMPLETION <br /> Holding Temperature: Orwn7Suia<, - <br /> Method: <br /> 4 <br /> GroutScreening Method: ' <br /> ff. <br /> Verified Chain of Custody: ❑Yes ❑No <br /> SPOILS <br /> Contamination Noted: ❑Yes eDNo <br /> If yes,spoils storage Location: r4� .wtt.a <br /> P 8 41( lon D{ _ <br /> Covered: ❑Yes ❑No <br /> If yes,material: s <br /> GROUTIN or DESTRUCTION Total Depth:_'Eigp ¢' <br /> th ater: 00, <br /> Grout Material: 4v MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 'L 5 R <br /> Casing Type: <br /> Well Installation []Well Destruction Blank Feet Screen Feet <br /> Slot Size: Nj <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: t [Sa y <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Ba s allons Ba s <br /> Thickest Thinnest 4Bags Thickest Thinnest .Bags Bentonite/Cement Mix 3%MIX 5%1�47 <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 <br /> 5 10 10 2B 2 Bentonite per 941b 2.82 <br /> 7.5 15 3 15 30 3 - <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 1 40 1 B 40 00 B 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.corn <br />