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SAN JOAQUIN Environmental Health Department <br /> —COUNTY <br /> \,c, Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> V-h.-I Inspector: MF+ 4-0, CONSTRUCTION <br /> Date: q P y" r/5�- o,.a• e1..tC <br /> Facility Address: bv/ Ltw,4er 4/4+-- <br /> Well Address: Total Depth: <br /> WP# d0396 j3 Well#: 0 "z —S Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: '5/4S// Screen Length From: To <br /> Driller Onsite: 139,6 Filter Pack From: To <br /> Consultant: 6 fiv Bentonite From: To <br /> Geologist: F&s K Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO —r casing <br /> height <br /> If yes,location and distance: <br /> SAMPLING ABOVE-6 Io D mum-Box <br /> CowLEnoN COMPLETION <br /> Holding Temperature: O o nd suAacv <br /> Method: o10„t <br /> Screening Method: <br /> Verified Chain of Custody: ❑ Yes ❑No n. <br /> SPOILS e <br /> Contamination Noted: ❑ Yes ❑No - <br /> If yes,spoils storage Location: stoned = R <br /> #eC#on <br /> Covered: ❑Yes ❑No _ g-W Pads <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: ys r <br /> n. TM• <br /> Depth to Water: tz' <br /> Grout Material: Oeaf [e..nn-f MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation AWell 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 ®Tremie ❑Other: <br /> Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Ba s allons Ba _ <br /> Thickest 7hinnezt #Bags Thickest minnest #Bags _ BentonitelCement Mix 3°/a Mlx 5%Mix <br /> 1 1 <br /> Bentonile er 47 Ib 1.41 <br /> 2.5 5 5 10 <br /> 5 10 x 10 20 2 Bentonite per 941b 1 2.82 4.7 <br /> 7.5 15 <br /> 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 iJ bJ�ha0 �I brs <br /> 15 30 6 30 60 6 L , <br /> 17.5 35 7 35 70 7 <br /> so 40 B 40 B0 B I� ta5 IE>0 10/16/2017 <br /> I) OS a&his <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468- 420 1 F 209 464-0138 1 www.sicehd.com <br />