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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> Monitoring Well/Soil Boring Inspection Report <br /> A <br /> Date: 6 Inspector: A. CONSTRUCTION <br /> Facility Address: 117ZO E. +61-p y L.K. CA <br /> Well Address: Total Depth: <br /> WP# Z.bo 1 r--753f Well#: G - 15 Drilling Rig Type: <br /> Soil Boring#: — Min 2" Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: LG. Screen Length From: To: <br /> Driller Onsite: <br /> O69 <br /> Filter Pack From: To: <br /> Consultant: UJood % <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 /> Holding Temperature: oowLE-riON COMPPLE-noN <br /> Method: G=nd sumac* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Noit• <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No — m P"+6A <br /> If yes, spoils storage Location: �tar�d EE <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 21ti�, G "�� <br /> Depth to Water: NZ P. <br /> Grout Material:l?x,�.�ov,i�G `�a1 �( nte�a� �vwrT MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 'yv 3Qy a�tlb�5 1 \ <br /> Casing Type: �,fl go TVCG ( 2 ,, 1, -biaw, 6, 1 <br /> [Nell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: =>e q,4 loo pi 6y bg(5 <br /> METHOD USED Bags Sand/Gravel: tt <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: &Ny;,,of <br /> Filter Pack Type/Size: <br /> ❑ Gravity Wremie ❑Other: Type of Method: <br /> wff-• `$1'gs op 1py>7-}o n;k 1.�szd (5C71 b 6ngs� <br /> Water Cement 471b Water Cement 941b M1 USti� <br /> Rallons Bags a III lons Bags a (56 9,1Ios^1 ar,V'Mhs of p"41*w A?All'u'n 'Tf <br /> Thickest Thinnest NBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 55% Mix t c too Pf, <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 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 1 ,1 <br /> 10 20 4 20 40 4 —Pe uti o f �bq,s' S�UI.� i^ bo'r l'w8 0( l qo <br /> 12.5 25 5 25 50 5 r <br /> 15 30 7 30 70 7 �k J)Uvjhjodl Ujt6 CAllyd 6V Sow PeAr�aV kZ- <br /> 17.5 35 7 35 i0 7 n 1 O' 1 <br /> 20 40 s 40 80 s OVA a gPT6\,VA C'0V4.'n tdV\ , GbnS-hsUc+ on 6f w-G�1, <br /> UU 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />