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'o pUiN <br /> (2SAN JOAQUIN Environmental Health Department <br /> " ` ^`j —COUNTY— <br /> NI Greatness grows {sere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: tc UcrL -L CONSTRUCTION <br /> Facility Address: <br /> Well Address: \tip it`�C Mkt, i;� r Total Depth: <br /> WP# C)'-� ��o Well#: Drilling Rig Type: `�t f <br /> Soil Boring#: l ejL Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: $�Ali Q6 1.1'&< <,�_P,4�Al i^ <br /> Driller Onsite: '�p,t;,� A� Screen Length From: To: <br /> Consultant: Filter Pack From: To: <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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE.GaoUNo <br /> Holding Temperature: COWLET10N COMMEMN <br /> Method: Ground Sudace <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> R. <br /> SPOILS x -_ <br /> y � O <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted M <br /> soon • = B <br /> Covered: ❑ Yes ❑No = g-,'W Pack <br /> If yes, material: 4' <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tt• n' <br /> Grout Material: ��Ny ,,,,y a V��%?s` MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation PBoring 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 FLI-lTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 so 5 <br /> is 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 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />