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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> _ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I -4 Inspector: `i CONSTRUCTION <br /> Facility Ad ress: 160L lucyioWofW . <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: DU 6 �oil Min 2"Annular EHD Seal Verified: ElYes El No <br /> mpany:Drilling Co 6 • 0Y ZScreen Length From: To: <br /> Driller Onsite: <br /> Consultant: (0 L Filter Pack From: To: <br /> Geologist: �.P l vt 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 casing <br /> If yes, location and distance: � height <br /> _qWT <br /> SAMPLING ABOVE•GfiCUND <br /> COWLMON COMPLETBox <br /> Holding Temperature: cornalErioN <br /> Method: G=ndsu lacy_F _ <br /> Screening Method: ar«a <br /> Verified Chain of Custody: ❑ Yes ❑No �n' <br /> _n. <br /> n. <br /> SPOILS k _ a <br /> Contamination Noted: ❑ Yes ❑No Td " <br /> If yes,spoils storage Location: <br /> �bitad yN, = B <br /> Covered: ❑ Yes ❑No — <br /> If yes, material: 1 = <br /> GROUTING or DESTRUCTION Total Depth: 35 L0 ` 0 '' 10 ` <br /> Depth to Water: �— <br /> Grout Material: MATERIALS/DEVELOPMENT- ./ <br /> Gallons of Grout Used: ti 1 Q <br /> 'U�"-I Casing Type: <br /> ❑Well Installation Well DestrucU R` (UJ Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction I_ <br /> D 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 )EiTremie ❑Other: Type of Method: <br /> Water Cement 4711a Water Cement94Bs <br /> ailons Bags allons Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5%MIX <br /> z5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 5o 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 11 40 80 3 <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 />