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. SANJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> •.!`,;,, ;,;,.,:`'� Giewness grows h,, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:Ibl1211020 Inspector: UtXat 1Afl (ak� CONSTRUCTION <br /> Facility Address: 06 E W&A1 t WAS <br /> Well Address: E undim vimA Total Depth: <br /> Wp# Well#: Prt4 Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes []No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: <br /> Filter Pack From: To: <br /> Consultant: Bentonite From: To: <br /> Geologist: 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 /> height <br /> If yes, location and distance: —low <br /> SAMPLING Aso -dROUND crwisT 80x. <br /> Holding Temperature: COWLErION compLEnoN <br /> or«na s"nas.—�----- <br /> Method: orT� <br /> Screening Method: <br /> Verified Chain of Custody: ❑Yes ❑No <br /> _.tt. <br /> SPOILS = a <br /> Contamination Noted: ❑Yes ❑No = s <br /> If yes,spoils storage Location: alottad `. _ 3 <br /> sarion <br /> Covered: ❑Yes ❑No ^ = yrvapxx <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth. - FA <br /> tt. <br /> Depth to Water: <br /> Grout Material: r1PXY1�dl j C 4�I b ball MATERIALS DEVELOPMENT <br /> Gallons of Grout Used: c1 Ab116n1 IAterAI Itfte loo asingType: <br /> s�I r yfU%kI3 <br /> []Wellip <br /> Well Installation Well Destruction �S \K11 Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation El Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> )Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 4714 Water Cement941b <br /> P7.5 <br /> ns BagsM <br /> Bags <br /> _ <br /> Thinnest 48295 est Haag Bentonite/Cement Mix 3% MIX 5% MIX <br /> 5 1 1 Bentonile per 47 lb 1.41 2.47 <br /> 10 2 2 Bentonile per 941b 2.82 4.7 <br /> 15 3 1 14 4 5 530 6 6 35 7 740 B 3 <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.corn <br />