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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 13 1z3 Inspector: 0Ay'a-r�r CONSTRUCTION <br /> Facility Address: )-A+?Z VL h,,i t c ox ,5k� t <br /> Well Address: Total Depth: _ <br /> WP# A A 7"37- Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: V mn t uurt v� r.I Ate\ Min 2"Annular EHD Seal Verified: ❑ Y��earrs LLLL C]No <br /> Driller Onsite: v <br /> Screen Length From: 1�7 To: <br /> Consultant: SS1r� 5 Filter Pack From: To: <br /> Bentonite From: To: ! < <br /> Geologist: S keJ ekq ag , <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes BIG' COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes Clio casing <br /> If yes,location and distance: � height <br /> SAMPLING ABOVEGROUND <br /> COMPLErION COMPLE-BOX <br /> Holding Temperature: cottrlETloN <br /> Method: Gmnd 6udac0 .-:F -- <br /> Screening Method: grad <br /> Verified Chain of Custody: ❑ Yes ❑No — Aa ,f <br /> n. <br /> SPOILS in <br /> a <br /> It, <br /> Contamination Noted: ElYes Z(No <br /> r =_ <br /> If yes,spoils storage Location: alonad ` = <br /> ►a lan v = 8 <br /> Covered: ❑ Yes ❑No — wI <br /> If yes, material: 16 _ '.. <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: t.1bt n• = tt. <br /> Grout Material: W I^ <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> �,p'' � l �J Casing Type: 7.µ y'V L <br /> tpyvell Installation ❑Well Destruction Blank S 7 Feet Screen 2Dt Feet <br /> /❑Boring Installation ❑Boring Destruction Slot Size: n �0 ZO <br /> Bags of Cement: 23 <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: U <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: 1-r 4tir'� <br /> Water Cement 471b Water Cement 941b <br /> 811ons Bags stations Basts <br /> Thickest Thinnest ItBags Thickest Thinnest kBags Bentonite/Cement Mix M�222 <br /> %MIX <br /> 2.5 s 1 s 10 1 Bentonite per 47 lb 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 4.7 <br /> 7.5 is 3 is 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> is 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 140 80 8 <br /> 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.coni <br />