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SAN JOAQUIN Environmental Health Department <br /> -COUNTY <br /> --grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ��I r7 I I y Inspector: r I Q. nom`,4"401- CONSTRUCTION <br /> Facility Address: 61950 11/. Lcwpf ` p cr�J4- (j, (,,o <br /> Well Address: Total Depth: <br /> WP# 6 W II#. Drilling Rig Type: <br /> Soil Boring#• 1 S Ir I Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: T�vro c c�� Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: ''e. L(o <br /> Bentonite From: To: <br /> Geologist: Grout From: To: <br /> Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes []No casing <br /> height <br /> If yes,location and distance: <br /> SAMPLING AWYE-GROUND CHRISW-Box <br /> COMPLETION COMPtEnON <br /> Holding Temperature: c3=nd sut>c. <br /> Method: <br /> grctA <br /> Screening Method: <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> SPOILS =_ _ -a <br /> � Y <br /> Contamination Noted: ❑ Yes ❑No = .. <br /> 0 <br /> If yes,spoils storage Location: slonad _ 3 <br /> a*clon rs _ <br /> Covered: ❑ Yes El No = g-w1wpack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth:-LO j i <br /> tt. <br /> Depth to Water: I'1 G W X <br /> Grout Material: �`FiA 7 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: (Ce 2 al c n 5 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Woring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> El Pressure Grout []Over Drill Filter Pack Type/Size: <br /> 0 Gravity ❑Tremie ❑Other: <br /> Type of Method: <br /> fl1020 <br /> Cement 471b Water Cement 94 lb <br /> Ba s allons Ba <br /> est IBags Thickest Thinnest xBags Bentonite/Gement Mix 3%MIX 5%MIX <br /> 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> z 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 3 15 30 3 <br /> 0 4 20 40 4 <br /> 5 5 25 50 5 <br /> 0 6 30 60 6 <br /> 5 7 35 70 7 <br /> 0 8 40 80 B <br /> 10/16/2017 <br /> 1 E. Hazelton Avenue Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />