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SAN JOAQUIN Environmental Health Department <br /> -- --COUNTY— <br /> Gren(ness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: Gv/•E C z/5'0 ovaS ��.zl <br /> Well Address: Total Depth: <br /> WP# OD39673 Well#: wA tOf Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 6j4&'j 1` <br /> Driller Onsite: .Bob Screen Length From: To: <br /> Consultant: 6 �tfs Filter Pack From: To: <br /> Geologist: Fvw 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 /> EE--y <br /> SAMPLING ABOVE-6OUND Crwtsrreox <br /> Holding Temperature: OOMPLETION COMPLETION <br /> Method: cvoundsutaN— <br /> Screening Method: <br /> Verified Chain of Custody: ❑ Yes ❑Non, <br /> SPOILS _ e <br /> Contamination Noted: ❑ Yes ❑No ° <br /> If yes,spoils storage Location: fi, EE <br /> slotted <br /> sac7on <br /> Covered: ❑Yes ❑No — g-wlPaec <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: yS = ' <br /> Depth to Water: ". Zt tt' — tt• <br /> Grout Material: WftS c evHt. 4— MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> []Well Installation WWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑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 KTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Baas _ <br /> Thickest Thinnest °Bags Thickest Thinnest °Bags _ Bentonite/Cement Mix 13% Mix %% Mix <br /> 2.5 s 1 5 10 1 Bentonite per 47lb 1 1.41 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2,82 4.7 <br /> 7.5 is 3 15 k 30 3 - <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 W 1o1G.S<k s °/7/5S <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 <br /> 20 40 3 40 BO 0 / <br /> 10/16/2017 <br /> jvw/y17"�'4 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />