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"`' , SAN JOAQUIN <br /> Envir®nmer Health Department <br /> —COUNTY— <br /> °,,rtca Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ) t, I l& Inspector: L,�- x��� CONSTRUCTION <br /> Facility Address: r01J $ A-,A- <br /> Well Address: Total Depth: <br /> WP# n03-7j�j S Well#:t,,/ Drilling Drilling Rig Type: <br /> Soil Boring#: g"' Z/E�'-9 Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: Q�v►�w.c Qr„��;�..,, tcw- <br /> Driller Onsite: 0 oe W-- . t)�s,,�,� „� Screen Length From: To: <br /> Consultant: ELM Filter Pack From: To: <br /> Geologist: t✓La„✓l-_ /'r l(J+ 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 <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING <br /> ABOVE-GROUND TY-BOX <br /> Holding Temperature: cowLErioN CC}3HRiSRS£T70N <br /> Method: Ground surface ... <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> n. <br /> SPOILS .__.____ft. <br /> Contamination Noted: ❑ Yes ❑No o <br /> If yes,spoils storage Location: alotud <br /> _= . <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: VI =F� <br /> Depth to Water: <br /> Grout Material: ­­+ <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: JLow <br /> � � Casing Type: <br /> ❑ E <br /> Well Installation dell Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation ❑Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED M- <br /> Bags Sand/Gravel: <br /> ❑Pressure Grout L�Over Drill Type/Brand of Bentonite: <br /> --// Filter Pack Type/Size: <br /> ❑ Gravity & remie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 94 lb <br /> gallons Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 4Bags Benton itefCement Mix 3%MIX 5°lo Miix <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 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 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />