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SAN-JOAQUIN EnvironmeriLdl Health Department <br /> 2 <br /> COUNTY -- <br /> Greatness grows here. <br /> MoonnitoringWell/Soil Boring Inspection Report <br /> Date: Inspector: )0 - OA <br /> ! <br /> . CONSTRUCTION <br /> Facility Address: Z/'. 4Kkc 7 <br /> Well Address: Total Depth: <br /> WP# ojW1`7 Ll Well#: Drilling Rig Type: <br /> Soil Boring#: S 1 —S L2,1 $ <br /> Drilling Company: l�af(o-CQ, —kCu�,l ��SvCj�`7yJ Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: ,� �6 <br /> ✓' Bentonite From: To: <br /> h <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑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-GROUND _ <br /> Holding Temperature: OO�'��ON CCOMPLEnoN <br /> Method: °round Sumacs <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes El No <br /> ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> C <br /> If yes, spoils storage Location: slotted = . <br /> &*clan <br /> Covered: ❑ Yes ❑Nog-yw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: V9One- n• n' <br /> Grout Material: 'nkt <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: '4S A c-) <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installationoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> []Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Ceme 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest rrBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.821 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 1 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> -1 basS 10/16/2017 <br /> 1868 E. Hazelton Avenue I td'ckton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />