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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:�0�� / � InspectIor: / 14- CONSTRUCTION <br /> Facility Address: o 'to <br /> Well Address: Total Depth: l I/I • �S /7 <br /> WP# 00'54V-25 Well#: Drilling Rig Type: <br /> Soil Boring#: 66 , 011--14Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: —F / <br /> Driller Onsite: ; 1 Screen Length From: To: <br /> Consultant: S '0.T: Filter Pack From: To: <br /> Bentonite From: To: <br /> Geologist: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: 0016PLETION �1.E71oN <br /> Method: G=nd SLwf=s <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes ❑No —`--n' <br /> ft. <br /> ft. <br /> SPOILS k <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: abMa <br /> Z� ) s�cSon W <br /> Covered: ❑ Yes ❑No oil , <br /> _ gr,,,w <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 770T <br /> Depth to Water: 14 1y N <br /> 6111''/ I Z� I % • — fL <br /> Grout Material: <br /> Gallons of Grout Used: $ , MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation MBoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> 1,L 8)t/ Filter Pack Type/Size: <br /> 6 • 1 I Type of Method: <br /> Gravity I�Tre le ❑Other: <br /> Water Cemenf Ib Water Cement 941b <br /> allons Bas leallons Bajzs <br /> Thickest Thinnest #Bags Thickest Thinnest ttBags Bentonite/Cement Mix 3% MI 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite perIb F---T-411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 1 2.821 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 1 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> 3 Q y0t- 1S 10/16/2017 <br /> 1868 E. Hazelton AvenueStockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />