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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness 3rov s !.rre. <br /> 2 Monitoring Well/Soil Boring Inspection Report <br /> Date: / Z( Inspe-c-t�por: S(A S s YG KCONSTRUCTION <br /> Facility Address: �� 2� Yt�DKSI f�taCyl <br /> Well Address: Total Depth: <br /> WP# 00 Y Z 069 Well#: Drilling Rig Type: <br /> Soil Boring#: — Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: /t V77 9 rf I r <br /> Driller Onsite: _17Y�YIK � Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING <br /> ABOVE-GROUND CHRISTY-BOX. ' <br /> Holding Temperature: COl'` LEMN =MPLEnON <br /> Method: Gmdha Surface <br /> Screening Method: gram <br /> Verified Chain of Custody: ❑ Yes 11 No <br /> ts. <br /> SPOILS - — - <br /> Contamination Noted: ❑ Yes ❑No = w <br /> If yes,spoils storage Location: aba _ s <br /> �i <br /> 3 <br /> Covered: Yes ❑No _ <br /> yy _ i, <br /> If yes, material: et! <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n- <br /> Grout Material: AM -(- et— <br /> Gallons of Grout Used: e-�_ �} S. MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> ❑Boring InstallationWoring Destruction Bags Slot Siziz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ GravityTremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 941b <br /> allons Bas gallons Ba s <br /> Thickest Thinnest "Bags Thickest Thinnest "Bags Bentonite/Cement Mix 3% Mix 5% MIX <br /> ---5 —1--10 1 --- Bentonite per 47 Ib 1.41 <br /> 5 10 2 10 1 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 5 25 50 5 <br /> 1s 30 6 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 Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />