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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> , . Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 4/1,6(M Inspector: CONSTRUCTION <br /> FacilityAddress:16631 U-1iGyu-^' �V-1&HfPr <br /> Well Address: Total Depth: <br /> WP#0V45-7v 5 Well#: Drilling Rig Type: <br /> Soil Boring#: WI W ),','v , L4 Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: GA <br /> Driller Onsite: JGc A Screen Length From: To: <br /> Consultant: kS l el Newer Filter Pack From: To: <br /> Geologist: lToreluA Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: El Yes ONO <br /> casing <br /> If yes, location and distance: height <br /> —QW7:F <br /> SAMPLING ABOVE-GROUND <br /> COAPLETIoN CNRISTYnON <br /> Holding Temperature: coMaLETioN <br /> Method: Ground sulac0 t <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ONO tt• <br /> ft. <br /> Ott. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ONO <br /> If yes, spoils storage Location: ;' _ o <br /> sawed 8 <br /> _ <br /> Covered: ❑ Yes ❑ sacdonNo — <br /> Ifyes, material: _ gnww'Pack <br /> GROUTING or DESTRUCTION Total Depth:ZC! 1-32 ,2.11 <br /> Depth to Water: 10 --(.S. iZt <br /> Grout Material: in eat MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: \ 6 <br /> Casing Type: <br /> ❑Well Installation CAWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> 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 f lxremie ❑Other: Type of Method: <br /> i <br /> Water Cement 471b Water Cement 941b <br /> allons Bags eallons Baas <br /> Thickest Thinnest Mits Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 1 Bentonite per 47 lb I 11AII 2.47 <br /> 15 <br /> 3 15 30 3 3 10 20 2 <br /> 7.5 15 Bentonite per 94 lb 1 2.021 4.7 <br /> 30 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 40 g 40 30 B <br /> St bays uses/ 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 />