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SANsJOAQUIN <br /> Environmek al Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z04 Inspector: / CONSTRUCTION <br /> Facility ddress: <br /> Well Address: 1 b UL - Total Depth: <br /> WP# Well#: 11AI 00 Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: W.— <br /> height <br /> SAMPLING AVE-GROUND <br /> Holding Temperature: COMPLETION COMP�LEnoN <br /> Method: G-ound Surface <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No -�—n <br /> it. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes < No a� <br /> If yes, spoils storage Location: abed <br /> sx�on � <br /> Covered: ❑ Yes LVo _ 9-VI+Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: Zq0 t M — n- <br /> Grout Material: <br /> Gallons of Grout UseeWell�D�estruction <br /> N (� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> El Pressure Grout )Qver Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ITremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest 7tBags Thickest Thinnest zBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 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 s0 5 <br /> 1s 30 6 30 60 6 <br /> 17.5 3 35 70 7 <br /> 20 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />