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SAN JOAQUIN Environmental Health Department <br /> —COUNTY <br /> Greatness groves here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> i <br /> Date: ?/?/Mwlnspector: 5t'Z vjfA< CONSTRUCTION <br /> Facility Address: , C. tide, i <br /> Well Address: ' / tal Depth: <br /> WP# 0C2 4 W II#: - S D illing Rig Type: <br /> tMrToring#: g 214 a1c <br /> Drilling Company: I AW 'W In 2"Annular EHD Seal Verified: ❑ Yes El No <br /> DrillerOnsite: MW.�j$ reen Length From: To: <br /> Consultant: q titer Pack From: To: <br /> Geologist: „� � ` entonite From: To: <br /> rout From: To: <br /> Public Water System Onsite: Yes COMPLETION El stove Pipe ❑Christie Box <br /> pA S1+0— <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: _-� height <br /> SAMPLING ABOVEGROUND <br /> CowLE nN COX <br /> Holding Temperature: corOMPLeTir+PtErioN <br /> Method: °° °S"i"'—F— <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Non• <br /> n. <br /> SPOILS n. <br /> Y O <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> �wn4a � •— 8 <br /> Covered: ❑Yes ❑No /I "cdangnival Pack <br /> c <br /> If yes, material: �� 1��'GN/`f <br /> LN <br /> GROUTING or DESTRUCTION Total Depth: bo l'd <br /> Depth to Water: <br /> Grout Material: �ofr <br /> Gallons of Grout Used: TERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well 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(em <br /> ver Drill <br /> Filter Pack Type/Size: <br /> El Gravity ie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags aallons Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags _ Bentonite/Cernent Mix 3% MIX 5%MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 g 40 8 0 <br /> 1-5 Qj zd IO►t 5 to 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 />