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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 3 N inspector:c� &,n,aVbYl CONSTRUCTION <br /> Facility Address: 1 � W rYG4Y11M4_ .ff,S4' 1,7 <br /> Well Address: Total Depth: <br /> WP#24 00 213b Well#: D?AVe Drilling Rig Type: <br /> Soil Boring#: rip 0I <br /> Drilling Company: GA10 GUh Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: jV11 a Screen Length From: To: <br /> Consultant: leofiUh Filter Pack From: To: <br /> Geologist: 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 /> SAMPLING ABOVE-GROUND <br /> coLFLErwN crtalsrveox <br /> Holding Temperature: cornaLErloN <br /> Method: °faun°suriacI <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑Non' <br /> ft. <br /> _n. <br /> SPOILS <br /> e <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes,spoils storage Location: abnod :.' <br /> soctlan <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 3 =_ •. <br /> Depth to Water: 1 (S)t n. n. <br /> Grout Material: NUA' - Cf/YYl(fnl <br /> Gallons of Grout Used: 4.6 0A II orgS MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring InstallationABoring 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 XTremie ❑Other: Type of Method: <br /> Water Cement 47111 Water Cement 94lb <br /> allons Bags allons Ba s <br /> Thickest Thinnest kBags Thickest Thinnest #Bags Bentonite/Cement MIX 3%MIX 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47lb 1 1.411 2.47 <br /> 5 10 2 10 20 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 /> 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 />