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S AN J OAQU I N Environmental Health Department <br /> C 0 U ra T•— <br /> Monitoring Well/Soil Boling Inspection Report <br /> Date: II3 Inspector: A- T t CONSTRUCTION <br /> Premise Address: Pw F,AV-.1 — <br /> WP#: eA194Y (A)PU0 15$$ Total Depth: <br /> Well#: ��-18 Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular Seal Verified: El Yes ElNo <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: ln)ooc� 2o���S Filter Pack From: To: <br /> s�� Bentonite From: To: <br /> Geologist: r did 7rmmM .A <br /> -U Grout From: To; <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No caeir.g <br /> If yes, location and distance: j ff77 T <br /> height <br /> 7"SAMPLING . <br /> Holding Temperature: COMPLETION cam,oh <br /> Method: c`D`jf—,! ' <br /> Screening Method: Pg' ¢ram <br /> Verified Chain of Custody: ❑ Yes ❑No9 _11`� — <br /> ft- <br /> t. <br /> tt. <br /> SPOILS = <br /> Q <br /> Contamination Noted: ❑ Yes ❑No - <br /> If yes, spoils storage Location: sl�ro-d 2hd L) 1 <br /> Covered: ❑ Yes ❑No <br /> - _ 10 <br /> If yes, material: S <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: —ft. IF 1 ft <br /> Grout Material: ct oe,__ :L-X �e,[j MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: IIACc j Casing Type: <br /> 5/Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction gags of Cement: "IM �iS <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> _/ Filter Pack Type/Size: <br /> El Gravity 5 I remie ❑Other: ,1 Type of Method: <br /> Ve'ater Cement 471b ';rr ater Cement 94lb �i c <br /> allons Bags oallons Bags �D41I1{/S g1rOU e�1 Td J L� , �te5� �4 rlvf <br /> Thickest Thinnest Bags Thickest Thinnest 4Bap W/MOhU,M hl-� 1"-5 <br /> 2.5 5 1 5 10 1 1 BentonitelCement Mix 3% Mix 5% Mix <br /> 5 10 2 10 20 1 2 Bentonite per 47 lb 1.411 2.47 <br /> 7.5 15 3 is c0 I a <br /> 10 20 4 20 40 4 Bentonite per 94 lb 2.821 4.7 <br /> 1?.5 25 5 ?5 50 I 5 1 G^ 1' <br /> 15 co I 6 30 60 6 Iy ID40.e6 � Vol\ <br /> 17.5 a5 - a5 70 I 7 <br /> ?0 4o 1 s 1 40 so s <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />