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SAN J OAQ U I N Environmental Health Department <br /> COUNTY= <br /> Greatness gra-ys !,.Pre. <br /> l Monitoring Well/Soil Boring Inspection Report <br /> Date: ! 2 Inspector: cpLtS C CONSTRUCTION <br /> Facility Address: l O-Y ` &yhpy-$ •, (_4(ol, <br /> Well Address: Total Depth: <br /> WP#'-7 YL(-CW Well#: Drilling Rig Type: _ <br /> Soil Boring#: —Z- Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: V <br /> Driller Onsite: VC,-9- �I Screen Length From: To: <br /> Consultant: e-`nn f e V Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: El Yes 11 No COMPLETION ❑Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes []No casing <br /> If yes, location and distance: height <br /> SAMPLING <br /> J18C7V c-fi A CKJND .. <br /> Holding Temperature: COWLETION cCOMP TION <br /> Method: G">,jnd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: El Yes ❑No <br /> If yes,spoils storage Location: sraa y <br /> Covered: ❑ Yes El No <br /> pack <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: 20� <br /> Depth to Water: k h e —ftft. <br /> GroutMaterial: /✓C4 clep 2 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: t?J (/0 S Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Borin Installation Slot Size: <br /> goring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> YGravity ❑Tremie ❑Other: Type of Method: <br /> Water cement 47 lb Water Cement 941b <br /> gallons Bas gallons Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest 4Bags Bentonite/Gement Mix 3% Mix 3% MIX <br /> 2.5 5 1 s 1 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 1 20 2 Bentonite per 94 lb 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 /> 15 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 I Stockton, California 95205 I T 209 468-3420 1 F 209 4640138 1 www.sicehd.com <br />