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SAN J OAQ U I N Environmental Health Department <br /> COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 12IZI ?O Inspector: �0.0 MGA St CONSTRUCTION <br /> Facility Address: 19,CtE A 0 5efyh Vt I� JIQ1141M <br /> Well Address: Total Depth: <br /> WP# 4141M Well#: Drilling Rig Type: <br /> Soil Boring#: 62 <br /> Drilling Company: rCl Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Gtt'1 h Screen Length From: To: <br /> Consultant: -T�_Tf4c 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: WT <br /> height <br /> SAMPLING ABOVE-GRAD <br /> Holding Temperature: COMPLETION CCOM�LE'nCN <br /> Method: G=nd Sia?as <br /> Screening Method: Drop <br /> Verified Chain of Custody: ❑ Yes El No �_ft. <br /> n. <br /> -ft. <br /> SPOILS w: <br /> Contamination Noted: ❑ Yes ❑No " <br /> If yes, spoils storage Location: atonaa <br /> s�cdon "— 8 <br /> Covered: ❑ Yes ❑No <br /> g-1 Pack <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ft• n' <br /> Grout Material: N16k ' <br /> Gallons of Grout Used: t Z MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation KBoring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bagallons Bags <br /> Thickest Thinnest ltBags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 3% Mix <br /> 2.5 v 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 t/ 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 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />