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SAN_J OAQ U I N Environme. .I Health Department <br /> I' t: —COUNTY— <br /> Gref iness grows here. <br /> Monitorin Well/Soil Boring Inspection Report <br /> Date: 0 S Z,oto Inspector: CONSTRUCTION <br /> Facility Address: ,,a ���v��� <br /> Well Address: Total Depth: <br /> WP# \,\\2-% \ Well#: f Drilling Rig Type: <br /> Soil Boring#:�,�< P ° Q�,,,;F,� `,•- �W�1 <br /> Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: <br /> ClL��l,O Filter Pack From: To: <br /> Consultant: t4-, <br /> Geologist: Q)A Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes b ,NO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes EPNo casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: COWPLETf°N coc�Pi=r►o <br /> Method: t3rnundSufxs T <br /> Screening Method: ofDCt <br /> Verified Chain of Custody: ElYes ❑No ft <br /> ft. <br /> ft. <br /> SPOILS <br /> — _ a <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: 910n2d _ <br /> sac9on - '— B <br /> Yes ❑No <br /> Covered: = �,,,�P.-K <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: _ <br /> Depth to Water:__ ; <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Gd\ <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation �IBoring Destruction Slot Size: <br /> vv' Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure GroutOver Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity *remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eallons Bag5 <br /> Thickest Thinnest 9Bags 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 /> 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 50 5 <br /> 15 3 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 209464-0138 1 www.sicehd.com <br />