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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 6-u-r1 Inspector: AN►srEw. CONSTRUCTION /J <br /> Facility Address: f 41 &C4 kilt 1—AV <br /> Well Address: Total Depth: <br /> WP# t9p3g493 Well#: Sdt- SG/ t Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: Bentonite From: To: <br /> Geologist: Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes,location and distance: � height <br /> SAMPLING A80VE fiROUND CHRM i'-BOX <br /> H COMPLETION COMPLETION <br /> Holding Temperature: <br /> Ground su —�--- <br /> Method: ors <br /> Screening Method: <br /> tt. <br /> Verified Chain of Custody: ❑ Yes ❑No ry, <br /> SPOILS — a <br /> Contamination Noted: ❑ Yes ❑No I° <br /> If yes,spoils storage Location: .loud S7 <br /> aactlon ,I <br /> Covered: ❑ Yes ❑No - anvil pads <br /> If yes, material: c <br /> I <br /> GROUTING or DESTRUCTION Total Depth: 3a ,S = ry <br /> Depth to Water: Zo <br /> Grout Material: f.1 ce.we» MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: �7§1 , Casing Type: <br /> ❑Well Installation Jg.Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation 11113oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill S1 Filter Pack Type/Size: <br /> 3e ;nte r4a Type of Method: <br /> ❑ Gravity ®Tremie C$Other: <br /> Water cement 47lb Water Cement 941b <br /> allons ea s allons Ba s <br /> Thickest Thinnest It Bags Thickest Thinnest 9Bags _ BentonitelCement Mix 3% Mix 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb I lAll 2.47 <br /> 5 10 2 10 20 2 1 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 5 5 <br /> 15 30 30 60 <br /> 17.5 35 7 35 70 7 <br /> 20 1 40 1 B 1 40 30 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 />