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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I Z� I$ Inspector: SQLAY-4"� t CONSTRUCTION <br /> Facility Address: j jjj E P( rnjvti I HAN*CC1 <br /> Well Address: 0() ? Q> 0115- 1 Total Depth: <br /> WP# G90 S Well#: Drilling Rig Type: <br /> Soil Boring#: F- I – – _0 Min 2"Annular EHD Seal Verified: ❑ Yes 0N <br /> Drilling Company: � ,D E <br /> Driller Onsite: 101 VL�jy j f'i� Screen Length From: To: <br /> C' Filter Pack From: To: <br /> Consultant: <br /> Geologist: f loll ct F fUAL 0 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: El Yes ❑No casing <br /> If yes, location and distance: height <br /> —aw, <br /> SAMPLINGABOVE-GROUND <br /> C <br /> Holding Temperature: COWFLETION COMPLETION <br /> Method: Ground Surf ac* <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> h. <br /> ft. <br /> SPOILS <br /> — a <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: sbd <br /> aacson <br /> Covered: ❑ Yes ❑No = gr_ <br /> vw Pack <br /> If yes, material: <br /> I <br /> GROUTING or DESTRUCTION Total Depth:A <br /> �� .r <br /> Depth to Water: Z n• tt• <br /> Grout Material: ' _ P IMV <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> .Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity 1I,Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> (� 15 30 1 30 11 1 <br /> pj i; �nJ 17.5 35 7 35 70 7 <br /> 0 20 40 8 40 80 8 <br /> � lct•dwckkE � bones 1 20 10/16/2017 <br /> !b�Lul I 6) b6"Os- <br /> 1868 E. Hazelton Avenue j Stockton, California 95205 1 T- 09 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />