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SAN JOAQUIN <br /> z � Environmental Health Department <br /> —COUNTY— <br /> �, Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: �V-► (A CONSTRUCTION <br /> Facility Address:'-;_6�< <br /> Well Addres Total Depth:--�� r <br /> WP# �b Well#: Drilling Rig Type: r► S� �r�/I <br /> Soil Boring#: A5 15 Ll Min 2" Annular EHD Seal Verified: ❑ Yes L1 No <br /> Drilling Company: 6 " K +1 <br /> its <br /> Driller Onsite: / Screen Length From: To: <br /> Consultant: �I - ( l ,5l4 ;PLO <br /> >; Filter Pack From: To: <br /> Geologist: C 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 /> SAMPLING ABOVEGROUND <br /> Holding Temperature: OOMPLflTION ccomP�_iFnoN <br /> Method: Ground Sulacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No -�---n' <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No =` <br /> If yes, spoils storage Location: stottad <br /> saclon <br /> Covered: ❑ Yes ❑No <br /> as — gravel pack <br /> If yes, material: C ll <br /> GROUTING or DESTRUCTION TotaDepth: ✓� 7��C� • __ <br /> Depth to Water: S H g n- n' <br /> Grout Material: <br /> Gallons of Grout Used: 0 of VI.S• MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction 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 PTremie ❑Other: Type of Method: <br /> 11-1 <br /> Water Cemen 471b Water Cement 941b <br /> allons Bas iozall ons BaRs <br /> Thickest Thinnest ttBags 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 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> V/ 6 O t ) ZC 0� 10/16/2017 <br /> 1868. Wazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />