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SANJOAQUIN Environmental Health Department <br /> " <br /> COUNTY <br /> °9Ao ai Greatness grows hem. <br /> Monitoring Well/Soil Boring Inspection Repgrt <br /> 1-30 <br /> Date: <br /> G <br /> Date: Inspector: /1(ASEEw• CONSTRUCTION 7 i J- <br /> Facility Address: 7-7ol M�z_�+��aM A-o <br /> Well Address: Total Depth: <br /> wP#r r, 7.93 P/r Well#: Drilling Rig Type: GiVIC S� <br /> Soil Boring#: / Min 2" Annular EHD Seal Verified: ❑ Yes No <br /> Drilling Company: V 1f <br /> Driller Onsite: -1A' Screen Length From: To: <br /> Consultant: US R'4-t "S Filter Pack From: To: <br /> Geologist: A,)O (rc 1)143,1 -t;6 j'fit. Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING A13OVE-GRCXJNO <br /> Holding Temperature: CONFLET1oN COP�MLEncN <br /> Method: Ground Sumacs + <br /> Screening Method: a�«n <br /> Verified Chain of Custody: ❑ Yes El No �tt' <br /> n. <br /> tt. <br /> SPOILS <br /> = e <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes,spoils storage Location: slottae _ B <br /> asc:on � <br /> Covered: ❑ Yes []No <br /> g-vW pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: _ <br /> Depth to Water:/6 <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring InstallationeBoring 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 ]Tre ❑Other: Type of Method: <br /> at Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thi Thinnest gs Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 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 �Ey Q rn��( uS�al r r � <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 1i(0 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 www.sicehd.com <br />