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SAN_JOAUUIN ; Environmen' Health Department <br /> _. <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:./ Inspector: IAMiVvc" CONSTRUCTION <br /> Facility Address: 'P 5 SS:j rJ . 14WY cl 9 <br /> Well A dress: Total Depth: <br /> WP# (95 Well#:, " W —Cj Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company:ln)Fh l[rt,tJ I )If Vida - D r To:1L� _ <br /> Drilleronsite: a� —--� wc Screen Length From: <br /> Consultant: " • . u n ' (ri v/ 1S.F}Ilter Pack From: � &• To: 1 1 0 , <br /> Geologist: l.t t U Bentonite From: ��i To: �g <br /> Grout From:.__ TO: J <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 Asovr asgout�p <br /> coe�i> 1wN comptnox <br /> Holding Temperature: coefptfrioH <br /> Method: crouna ssstac, 7 <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Noa• <br /> ft. <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes ❑No = o <br /> If yes, spoils storage Location: sto rod = 'a <br /> covered: ❑ Yes El No �­1 Pack <br /> if yes, material: rr <br /> GROUTING or DESTRUCTION Total Depth: J _ •. <br /> Depth to Water: V10 (. a U y1 i i 1 q r tt' <br /> Grout Material: ywa-F C1A6g2A6+ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Q cs(© <br /> Casing Type: r"�H �{jQ '2 <br /> Well Installation ❑Well.Destruction Blank qQ Feet Screen_'ZD Feet. <br /> Slot Size: () , CIO <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: L4 N <br /> METHOD USED Bags Sand/Gravel: IOCx�JrS <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Z 1 �� <br /> Filter Pack Type/Size: <br /> ❑ Gravity f 7rem f2 ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall Bags allons Bags <br /> Thickest Thinnest gBags Thickest Thinnest 9Bags SentoniteiCetnent Mix 3% Mix 50% Mix <br /> 2.5 s 1 5 1n 1 Bentoniteper47lb 1.41 2.47 <br /> s 2 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 75 15 3 15 W 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 . 6 <br /> 175 35 7 35 TO 7 <br /> 20 40 8 1 40 00 0 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />