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SAN JOAQUIN <br /> EnvironmeilLal Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Q Monitoring/Well/Soil Boring Inspection Report <br /> Date 1 ,,DIn ctor: � a_ CONSTRUCTION <br /> uc V <br /> iFacility Address: <br /> Well I <br /> Address:d Zap �{ 2 3 r ✓ /• Total Depth: <br /> WP# 00 u( n 6 Well#: - � � Drilling Rig Type: I <br /> Soil Boring#: Ck Min 2" Annular EHD Seal Verified: ❑ Yes [I No <br /> Drilling Company: (Ok- e <br /> Driller Onsite: � AM Screen Length From: To: <br /> r� 5 Filter Pack From: To: <br /> Consultant: <br /> Geologist: 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 /> 37 <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION �t�FnoN <br /> Method: Ground Six' <br /> Screening Method: 01 grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> R. <br /> it. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stood ` <br /> s�eson <br /> Covered: ❑ Yes ❑No _ gr., +pack <br /> If yes, material: =_ <br /> GROUTING or DESTRUCTION Total Depth: �Q • __ <br /> Depth to Water: V7 0V19-- n• tt' <br /> Grout Material: <br /> Gallons of Grout Used: ,,�, MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑B Slot Size: <br /> oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> fig Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cemen 471 Water Cement 94lb <br /> allons Bags eallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 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 /> l 6°5 Z�S 10/16/2017 <br /> 1868 E.'Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />