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FUty� <br /> SANJOAQUIN Environmental Health Department <br /> —COUNT Y— <br /> i <br /> 'o.'%cssml`�'' Greotness grows here. <br /> tt / Monitoring �Well/Soil Boring Inspection Report <br /> Date: 1 ` tit Inspector: v J `^ CONSTRUCTION <br /> Facility Address: ACC i L Ave•)S-OCK:6071 <br /> Well Address: Total Depth: <br /> WP# neN�102 Well#: Drilling Rig Type: <br /> Soil Boring#: Min r Annular EHD Seal Verified: ❑Yes El No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: S AT Bentonite From: To: <br /> Geologist: l'v1 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 2tso ° ctlrilsn.eox <br /> 00MPL6'fxaN commEngN <br /> Holding Temperature: <br /> Method: yra t <br /> Screening Method: <br /> Verified Chain of Custody: ❑ Yes ❑No tt. <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: B <br /> od&W ac5en <br /> Covered: ❑Yes ❑No = flrvayauc <br /> If yes,material: u :' <br /> GROUTING-or-DESTRUCTION Total Depth:--1-5---- M - tt• <br /> Depth to Water: ^-Lo <br /> PF <br /> Grout Material: tat C M wc' MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ^^ 91 eta d" Casing Type: <br /> []Well Installation &ell Destruction Blank Feet Screen Feet <br /> Slat Size: <br /> ❑Boring Installation El Boring 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 XTremie ❑Other: <br /> Type of Method: <br /> water cement471b Water cement941b <br /> alisns Bagsfffi <br /> Bags <br /> Thickest Thinnest a Bags est BBags Bentonite/Cement Mix 3% Mix 3% Mix <br /> z.s 5 1 1Bentonite per471bs 10 2 2 Bentonite per 94 ID7.5 15 3 310 20 4 412.5 25 5 515 30 6 617.5 35 720 40 B B 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 />