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SAN JOAQUIN Environmental Health Department <br /> COUNTY- <br /> 0 o " Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> ,p <br /> Date: /17174 Inspector: L CI&y CONSTRUCTION <br /> Facility Address:3�ff� WcrioftuCw-cf, VoicAdiirctj <br /> Well Address: Total Depth: <br /> WP#0045-S;r.j Well#: 1� 6 Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: &S <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: V le1j wWff Filter Pack From: To: <br /> Geologist: U&n2icita 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 ONO casing <br /> If yes, location and distance: IIffT height <br /> SAMPLING ABOVE-GROUND <br /> COWLS ION COMPLETION <br /> Holding Temperature: co6.wtFrioN <br /> Method: Ground sufx. T <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes ❑No �tt• <br /> n. <br /> SPOILS ./ = <br /> kv — n <br /> �1 — J <br /> Contamination Noted: ❑Yes []No — <br /> If yes,spoils storage Location: .monad ,.j _ <br /> .action _ 8 <br /> Covered: ❑ Yes ONO granml pock <br /> If yes, material: _= <br /> a <br /> GROUTING or DESTRUCTION Total Depth:_ <br /> Depth to Water: S.l t n. LIM ft. <br /> Grout Material: VI ea.- epwa eu.� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 2'1 <br /> Casing Type: <br /> []Well Installation fWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Baring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Pressure Grout []Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity CFYemie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest pBags Thickest Thinnest +♦Bags BentonitelCement Mix 3°/a MiX 5%MIX <br /> 2.5 s 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> s 10 2 10 zo 2 Bentonite per 94 lb 1 2.821 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 /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> % U S t-46CCA 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 />