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i <br /> SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Gre°lness grows Kerr. <br /> Moni�to)ring Well/Soil Boring Inspection Report <br /> Date: VZ3 Inspector: CONSTRUCTION <br /> FacilityA dress: 500 f r-PO! L� � <br /> � <br /> Well Address: �� Total Depth: �. i � <br /> WPN Wellli: Drilling Rig Type: 12 <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Screen Length From: 2S To: 'q-5 <br /> DrillerOnsite: Ge. <br /> Consultant: �� Filter Pack From: To: <br /> Bentonite From: To: <br /> Geologist: —1-Ot <br /> Grout From: ( Ot_ 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 /> :1w <br /> SAMPLING ABOVE-GROUND CMMM,.so)( <br /> Holding Temperature: ooM1wLETioN COMPLETION <br /> Method: Ground sula <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = " <br /> If yes, spoils storage Location: ' <br /> do <br /> sec m = <br /> tl°n { <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation El Boring Destruction gags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 9416 <br /> ailoni Bags uallons Be <br /> Thickest Thinnest Hags Thickest Thinnest #Bags BentoniteJCementMix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per47lb 1 1.411 2.47 <br /> 5 10 2 l0 20 2 1 Bentonite per 94lb 1 2.821 4.7 <br /> 7.5 15 3 15 30 3 - ////��)� <br /> 1. 20 4 20 40 4 �� I 0 oz+�� , <br /> 12.5 25 5 25 50 5 '�Av/'-C <br /> 15 30 6 30 70 4 ,3 t CY 90 <br /> 0 U <br /> 175 35 7 35 70 7 f �-D v I <br /> 20 40 8 40 80 8 7 � , . 1 <br /> I Z1 � z3�'fZ.� V�.i 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 />