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AN - :JOAQUIN <br />COUNTY <br />Greo tne.ss grows here <br />Environmer Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: z/t„vi Ly Inspector: L..4r)(44, <br />Facility Address: ilag-Co b1/4/•,-Ane.‘,4w, Cierq <br />Well Address: <br /> <br />WP# <br />Soil Boring: <br />Drilling Company: <br />Driller Onsite: <br />Consultant: &v.:7.4,-0A- <br />Geologist: <br />CONSTRUCTION <br />knit-) <br />Total Depth: <br />Well#: (A-11 OW 2 swzi< Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ED Yes ElNo <br />To: <br />To: <br />To: <br />To: <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />El Yes ON° <br />LI Yes EN° <br />El Stove Pipe <br />casing <br />height <br />EIChristie Box COMPLETION <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />cl-Ffsrr-40x • <br />COMPLETION <br />Verified Chain of Custody: <br />SPOILS <br />El Yes EN° <br /> <br />Contamination Noted: El Yes lilf\lo <br />If yes, spoils storage Location: <br />Covered: El Yes ONo <br />If yes, material: <br />tsa )to-a /7-7. 5 C4- ft. <br />MATERIALS/DEVELOPMENT Gallons of Grout Used: 64 ox, t <br /> <br /> Casing Type: I 5-1 <br />OWell Installation ern r ion Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 2-Slis <br />Grout Material: <br />El Boring Installation El Boring Destruction <br />METHOD USED <br />Mfressure Grout DOver Drill <br />El Gravity IDTremie nOther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest 48a8s <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <br />7.5 15 3 15 30 a <br />10 20 4 20 40 4 <br />12.5 25 5 .25 50 5 <br />15 30 s 30 GO 6 <br />17.5 35 7 35 70 7 <br />20 AO 8 40 80 a <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />10/16 /2 017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com