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3 0 ha, 3 10/16/2 017 <br />1868 E. Hazelt Ave ue Stockton, Cafornia 95205! T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />SAN,-JOAQUIN <br />COUNTY— <br />grows here <br />Environmer Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />SAMPLING <br />Holding Temperature: <br />Method: <br />D Yes EINo Verified Chain of Custody: <br />SPOILS <br />LI Yes ON° Covered: <br />If yes, material: <br />Date: Inspector; <br />Facility A dress <br />Well Address: <br />WP# /JP CFO (D?_i <br />Soil Boring#: <br />Well tIAL--5 <br />Drilling Company: <br />Driller Onsite: co, us <br />Gs 6 <br />Cr& /64&(,,44 <br />Consultant: <br />Geologist: <br />Public Water System Onsite: El Yes ONo <br />Domestic Well Onsite: D Yes ON° <br />If yes, location and distance: <br />Screening Method: <br />Contamination Noted: LI Yes [Wo. <br />If yes, spoils storage Location: <br />GROUTING or DESTRUCTION Total Depth: 3() l i t'S <br />Depth to Water: f i 1/1 r-- <br />Grout Material: /-4 /...a.1- ejz.v.....o.v..4--- <br />Gallons of Grout Used: go , 70 / <br />DWell Installation Xell Destruction <br />LIBoring Installation DBoring Destruction <br />METHOD USED <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes EINo <br />To: <br />To:• <br />To: <br />To: <br />COMPLETION LI Stove Pipe <br />cas ing <br />height <br />EIChristie Box <br />CHRISTY-SOX <br />COMPLETiON <br />ti. <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />4 <br />Water <br />gallons <br />Cement 47ib <br />Bags <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thrckest Thinnest 14 Bags Thickest Thinnest 4 Bags <br />25 5 1 5 10 1 <br />5 10 2 10 20 2 <br />7,5 15 3 15 ao a <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 g 40 80 8 <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 />D Gravity <br />OPressure Grout P{)ver Drill <br />remie 00ther: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: