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SA N _J OAQ U I N Environmer I Health Department <br /> COU NTY— <br /> Grentress arcws here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ` 7- Zaz-0 Inspector: CONSTRUCTION <br /> Facility Address:�pj �,L.p�,, �,�Q ,S� / Q„��pN "N-V <br /> Well Address: Total Depth: <br /> WP# -\\.-L 'bWell#: W\N, Drilling Rig Type: <br /> Soil Boring#: Sb- l"75 r `\ L� Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> ��� Bentonite From: To: <br /> Geologist: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes o COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 40 casing <br /> If yes, location and distance: height <br /> SAMPLING ASOvE-GROUND <br /> Holding Temperature: COWLET1ON «,P N <br /> Method: G=ndStrtaca <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No R- <br /> fi. <br /> ft. <br /> SPOILS = <br /> rY � ao <br /> Contamination Noted:' V , ❑ Yes ❑No <br /> If yes,spoils storage Location: ONS slotted <br /> Covered: kYes El No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: \-U,- \ ft• n <br /> Grout Material: N-"t <br /> Gallons of Grout Used: (0,Z) �& MA nERTIALe/DEVELOPMENT <br /> g yp <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity �LTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> gallons Bas eallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest ttBags 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 30 3 <br /> 10 20 20 40 4 <br /> 12.5 2F 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 so 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />