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SANeJOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date l'�/ Inspector: ��D' _ CONSTRUCTION <br /> Facility Address: 17yoo Aeqt?A-'�' <br /> Well Addre Total Depth: <br /> WP# 0 Well#: Drilling Rig Type: S'A <br /> Soil Boring#: <br /> Drilling Company: 51 a'9- •�,y Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite:� o Screen Length From: To: <br /> Consultant: p Filter Pack From: To: <br /> Geologist: -ti!/yj 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: Ttl height <br /> SAMPLING ABOVE-GRCUND <br /> Holding Temperature: CQWQLETION COMPLETMIN <br /> Method: Ground Sufa`y <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No n' <br /> M <br /> n <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: awn" ` _ s <br /> gig 9 3 "`d°" <br /> ❑ ❑ = a <br /> Covered: Yes No 5I _ f <br /> � <br /> If yes, material: g2 �z2�' <br /> GROUTING or DESTRUCTION Total Depth:_ 3173i <br /> Depth to Water: 10-/ -P4 5 �' n. <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 2a0 a <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring InstallationyBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity 124Tremie ❑Other: Type of Method: <br /> Water Cemen 471 Water Cement 941b <br /> Ilons Bas eall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3%Mix /o Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 <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 /> I q 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />