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SAN JOAQUIN Environmetikal Health Department <br /> —COUNTY <br /> Greatness grows 6::r-. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 't ' ptn Inspector: GIPo LtndSA1� CONSTRUCTION <br /> Facility Address: tA\ E ft11 q \AoL\l <br /> Well Address: 10 �� Total Depth: <br /> WP# 3 qI b Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: ��LgAIj, <br /> Driller Onsite: (Z@xt Screen Length From: To: <br /> bh <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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-411ROUNl7 c-Mmrr-sox <br /> Holding Temperature: COLFLE ION coMPLEnoN <br /> Method: Gtrwnd Ssrlac, _ _ <br /> Screening Method: o1an <br /> Verified Chain of Custody: ❑ Yes ❑No 4rft. <br /> ft. <br /> _e. <br /> SPOILS = .: <br /> Contamination Noted: ❑ Yes ❑No 'F <br /> If yes,spoils storage Location: 4101t1d <br /> acctlon <br /> Covered: ❑ Yes ❑No � — <br /> _ ': gnvdpecx <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth:Ab±t <br /> Depth to Water: ft. tt. <br /> Grout Material: C'2hIMt (41- Ib balks MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ID t1ANy)S <br /> Casing Type: <br /> ❑Well Installation 1LWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑BoringDestruction 3 ba S Slot Size: <br /> Bags of Cement: <br /> METHOD USED EX 10d10n Q�� nS Bags Sand/Gravel: <br /> a Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bale; allons Bags <br /> Thickest Thinnest RBags Thickest Thinnest aBags Bentonite/Cement MiX 3% MIX 5%MIX <br /> 2.5 s 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 15 1 30 3 , <br /> 10 20 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 />