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SAN JOAQUIN Environmental Health Department <br /> COUNT Y <br /> ���' Greutnrs> yrows I�erc. <br /> 7CIF � <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: V 1 Inspector: N►46Ee-n'1 CONSTRUCTION P r <br /> Facility Address: Z9Go Ei�e-wo,14 S+ <br /> Well Address: Total Depth: <br /> WP# (y 31 06 y Well#: Drilling Rig Type: <br /> Soil Boring#: 131, 2, 3, Lf, 5-1(P <br /> Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Aj <br /> Drilling Company: *Z <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: tr;H..2s•w <br /> 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: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONPLET ON coti+PtEncN <br /> Method: Ground Sl rtaco <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �tt. <br /> n. <br /> tt. <br /> SPOILS = <br /> e <br /> Contamination Noted: ❑ Yes ❑No <br /> C <br /> If yes,spoils storage Location: (3� 151 abttnd <br /> Covered: ❑ Yes ❑No (33 <br /> If yes, material: 131 <br /> GROUTING or DESTRUCTION Total Depth: <br /> 1 <br /> Depth to Water: 37 r L� <br /> Grout Material: &'qjL /rvkj <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation t(Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill 13L -Lo Filter Pack Type/Size: <br /> ❑ Gravity PA„ <�l <br /> �Tre Other:Flee�tf/ Type of Method: <br /> a r ce 71b Water Cement 941b <br /> Ilon ass leall ons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest )tBags 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 1 80 8 <br /> V Z-0 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 />