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SAN JOAOUIN Environmental Health Department <br /> —COUNTY— <br /> (;realness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: 5A.1 i r%(6 CONSTRUCTION <br /> Facility dress: 1K7+t N• MlroX <br /> Well Address: Total Depth: <br /> WP# ()()4g IN 2 Well#: Drilling Rig Type: <br /> Soil Boring#: R 2 <br /> Drilling Company: C Min 2"Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 5 t?1 gA Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-&IOMD <br /> COMPLETION CHRI.-Y-Box - <br /> Holding Temperature: compt.E ioN <br /> Method: c*° dsuta°' <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No 1 H <br /> _ft. ft <br /> SPOILS <br /> J — a • <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> tbttW <br /> Covered: ❑Yes ❑No stationGra, <br /> Pack' <br /> If yes, material: q o -' � <br /> GROUTING or-DESTRUCTION Total Depth: L 21 <br /> Depth to Water: f4 <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Moring Destruction Slot Size: <br /> ��p Bags of Cement: <br /> METHOD USED y(p�� Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill �)o Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> Water ant 471b Water Cement 94lb <br /> allons Bags gallons Bags <br /> Thickest Thinnest s Thickest Thinnest I MBags renlonite/Gennentilillix 3% MIX 5%MIX2.s s 1 s 10 1 8ntonite per471b 7.41 2.475 10 2 10 20 2 8ntonite 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 /> 1s 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 30 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.com <br />