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SAN J OAQ U I N Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report o <br /> Date: Inspector: A14SECi14CONSTRUCTION <br /> Facility Address: 19&n, Por-E Ael -A <br /> Well Address: Total Depth: <br /> WP# '0039Zy9 Well#: Drilling Rig Type: A",Vie- 43 6� <br /> Soil Boring#: 8Y <br /> Drilling Company:� Ar.'C!a'�y Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> � 6!!:v <br /> Driller Onsite: CA/A �P;Lr/G Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: 7oey 4//,—Yy�.3.5s'Sf Bentonite From: To: <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 /> iii <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COf"F�ION MN <br /> Method: Ground Surf=* <br /> Screening Method: 51>1 grow <br /> Verified Chain of Custody: ❑ Yes El No y---n' <br /> ft. <br /> tt. <br /> SPOILS y <br /> Contamination Noted: El Yes El No <br /> If yes, spoils storage Location: 1 slotted <br /> /�.. s�o9on r — <br /> Covered: El Yes ED]No g-+,hack <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: <br /> w" <br /> Depth to Water: ,f n• <br /> Grout Material: teww* >` <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation XBoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> 9LPressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity iXTremie ❑Other: Type of Method: <br /> ter Cement 471b Water Cement 94 lb <br /> s Bas gall ons Bags <br /> Thickest Thinnest 1J Bags Thickest Thinnest 11 Bags Bentonite/Cement Mix 3% Mix 3% 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 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 40 80 8 <br /> 19 ID ss�q(�Q•� M� X 10/16/2017 <br /> 3 <br /> 18681. Hazelton Avenue Stockton, California 95205 1 T 209468-34201 F 209464-0138 1 vwvw.sicehd.com <br />