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SAN JOAQUIN Environmental Health Department <br /> --COUNTY— - <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: (fir/ CONSTRUCTION <br /> Facility Address: 2 LfS6 a �►L~ t A v <br /> Well Address: Total Depth: <br /> WP#6(2 O ' 9-4LtS Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: o— r %K <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: S ASS oci Filter Pack From: To: <br /> Geologist: ()yyib-V-- Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: 0OW'LET1ON CO#APLenON <br /> Method: G=nd Surlact <br /> Screening Method: o.an <br /> Verified Chain of Custody: ❑ Yes 11 No <br /> H. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: .bn�d _ 0 <br /> sac�an j' <br /> Covered: El Yes El No w = graw- +pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 35 <br /> Depth to Water: r1 n- n' <br /> Grout Material: A/?mac [ Y�t <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation'*Jgboring 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 NTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Basgallons Bags <br /> Thickest Thinnest »Bags Thickest Thinnest ttBags 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 /> 2.S /A Y, 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />