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u SAN J OAQ U I N Environmental Health Department <br /> -COU NTY—- p <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: /✓11SEEsu CONSTRUCTION <br /> Facility Address: (v&_ j-j W &/k-v4 Lj.� j2e� <br /> Well Address: Total Depth: <br /> W P# ee)3'1K1 al Well#: Drilling Rig Type: <br /> Soil Boring#: CP' 2 /3 Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company:A4i-01*1 6ga&, 6e'd <br /> Driller Onsite: jQOnnQ;.f•• Screen Length From: To: <br /> rt�a�p.-.,. <br /> Filter Pack From: To: <br /> Consultant: <br /> Bentonite From: To: <br /> Geologist: kr,`s <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 /> SAMPLING AWVE-GROUND <br /> Holding Temperature: CONF'LEUDN COMPLEMN <br /> Method: Ground Surf=* <br /> I Mf <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> n. <br /> n. <br /> SPOILS /)13 L = <br /> Contamination Noted: ❑ Yes 0 N <br /> If yes,spoils storage Location: &tottpo = - <br /> 3� &scion _ B <br /> Covered: El Yes ON 7r Prix e <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: Z-01 <br /> Grout Material: IVek c¢rr✓ <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation &n3oring 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 RTremie ❑Other: Type of Method: <br /> Cement 471b Water Cement 94 lb <br /> \vallcmsBas jZa11111 ons Bags <br /> Thickest Thinnest aBags Thickest Thinnest tlBags 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 1 25 5 25 50 5 <br /> 15 1 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 B <br /> q0 5, 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />