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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> f� Monitoring Well/Soil Boring Inspection Report <br /> Date: <br /> V 7 /ZZ in ector: v L" �"`� CONSTRUCTION <br /> Facility Address: � ��CI Ft C I/2.IcS� oh <br /> Well Address: Total Depth: <br /> WP# W4 1�2 Well#:_LM- Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: CGS Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: AT Bentonite From: To: <br /> Geologist: -.TO L Lin Grout From: To: <br /> Public Water System Onsite: ❑Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> height . <br /> If yes,location and distance: <br /> SAMPLING ABovE.Ga Out <br /> .40 crwtsr"-sox <br /> CONisLE'n0N COMPLETION <br /> Holding Temperature: L3<o r4sulac*7� <br /> Method: grout <br /> Screening Method: —_n. <br /> Verified Chain of Custody: ❑Yes ❑No n• <br /> ._n. <br /> SPOILS <br /> ❑No ` m <br /> Contamination Noted: ❑Yes <br /> If yes,spoils storage Location: ilon°d <br /> ac°tlon <br /> Covered: ❑Yes El No anVW Pack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: 110 ft. <br /> — tt. <br /> Depth to Water: '�' <br /> Lo <br /> Grout Material: � MATERIALS/DEVELOPMENT <br />_ Gallons of Grout Used: I 0 0 14F ft'� Casing Type: <br /> Blank Feet Screen Feet <br /> ❑Well Installation dell Destruc n Slot Size: <br /> ❑Boring Installation ❑Baring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill��7wS Srv&ti dK� Filter Pack Type/Size: <br /> p,r.�wb Frme4 Type of Method: <br /> ity A�r ie ❑Other: <br /> Water cement 471b Water cement 941b <br /> allons Ba s allons Be <br /> Thickest Thinnest Bags Thickest Thinnest Il Bags BentonitefGement Mix 3%MIX 5%MIX <br /> 1 Bentonite per 47 lb 1.41 2.47 <br /> 2.5 5 1 5 10 Bentonite er 94lb 2.62 4.7 <br /> 5 lg 2 30 20 2 <br /> 1.5 15 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 <br /> 25 5 25 50 5 15 30 6 30 60 6 <br /> 20 35 <br /> 7 35 70 7 <br /> 20 4o B 40 80 B 10J16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />