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° SANJOAQUIN <br /> Environmental Health Department <br /> �,c� •`",�/ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:4114/Z 4 Inspector: CONSTRUCTION <br /> Facility Address:�691 C (QVct�y <br /> Well Address: �� Total Depth: <br /> WP#00453ys Well#:W36ti)L Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company:li_ <br /> Driller Onsite:�*11 Screen Length From: To: <br /> Consultant: I,SIPr h PeW e, Filter Pack From: To: <br /> Geologist: jiZw-rAu,g Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No Y casing <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-GnouND <br /> CCI&PLEMON COMPLE• ON <br /> Holding Temperature: cornrlF7IoN <br /> Method: Orcuod Su �--- <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> SPOILS = <br /> Contamination Noted: ❑Yes ❑No <br /> If yes, spoils storage Location: ' <br /> s <br /> slotted _ � <br /> Covered: El Yes ❑No 9 'on w•w+lack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 6 n• — n• <br /> Grout Material: "I-cd Prw.e MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 57 au IIeHg <br /> �� Casing Type: <br /> ❑Well Installation PMell Destruction Blank Feet Screen Feet <br /> El Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Pressure Grout Dover Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity 1ZTremie ❑Other: Type of Method: <br /> Water lCement 471b Water Cement941b <br /> allons Bags eations Baits <br /> Thickest Thinnest pBags Thickest Thinnest uses: Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.s s 1 s 10 1 Bentonite per 47lb 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 lb 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 3 40 30 8 <br /> 8(0�S use A 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 />