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SAN. JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I M Inspector: CONSTRUCTION <br /> Facility Address: k SCJ\ L�Xa2a S`►? C� V.`� <br /> Well Address: Total Depth: <br /> WP# Vl � Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling ing#:Com `A1 R Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: �_\AA Wit& Filter Pack From: To: <br /> Geologist: k�� 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 El No casing <br /> If yes, location and distance: height: <br /> WT <br /> SAMPLING AWVE-GROUND <br /> COWFLErION cta�lM-sox <br /> Holding Temperature: COMPLETION <br /> Method: GrwndSuface T <br /> Screening Method: groan <br /> Verified Chain of Custody: ❑ Yes El No <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No r <br /> If yes,spoils storage Location: <br /> stoned =_ <br /> sac�on — <br /> Covered: ❑ Yes ❑No paCk_ <br /> If yes, material: '` <br /> GROUTING or ESTRUCTIO To I Depth: __ <br /> Depth to Wat r: l4) - ' <br /> Grout Material: Wj�ck < <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Jeet <br /> Slot Size: <br /> El Boring Installation( Boring Destruction Bags iz Cement: <br /> METHOD USED (( Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Gement 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 /> Z k " 0�_ Uli'-� cu'X(i,3V Lc�-1 lbs 1 D Ta . 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 />