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cZ SANsJOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> c�cir Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ?o Inspector: A? md-o CONSTRUCTION <br /> Facility Address: acs ✓�14•%t <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: bl] "t%* Z)jC <br /> Drilling Company: 'lit( M-) Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Gc-s Le �LrL Filter Pack From: To: <br /> Geologist: – Zds✓ 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: height <br /> WT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWP�1ON COMPLE oN <br /> Method: Ground Surfars <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —tt' <br /> tt. <br /> tt. <br /> SPOILS k; <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted _ - <br /> aKSon — <br /> Covered: ❑ Yes ❑No _ gm„*1 pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 7/ <br /> Depth to Water: Mej G.d tt• tt' <br /> Grout Material: NOg-F test-.-6 <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation []Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation g Slot Size: <br /> rin Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie [06ther: rI''"o f*4' Type of Method: <br /> C ent 471b Water Cement 941b <br /> allo Bags- 28110 ns Bags <br /> Thickest Thinnest J1 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />