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. . . . . . . . . . . . <br />`,« SAN JOAQUIN <br />Environmental Health Department <br />—COUNTY— <br />,•: Gr'�utness qra vs here_ <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: t4 JS V/ Kr <br />Facility Address: Z'OCK� '^ <br />Well Address: <br />t— <br />WP# Well#: <br />Soil Boring#: <br />Drilling Company: 1-y! <br />Driller Onsite: vc'ri <br />Consultant: f �'iv�� <br />Geologist: &ZW <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes El No <br />SAMPLING <br />Filter Pack <br />Holding Temperature: <br />To: <br />Method: <br />From: <br />Screening Method: <br />Grout <br />Verified Chain of Custody: <br />❑ Yes []No <br />SPOILS <br />10 <br />Contamination Noted: <br />❑ Yes El No <br />If yes, spoils storage Location: <br />15 <br />Covered: <br />❑ Yes El No <br />If yes, material: <br />3 <br />CONSTRUCTION <br />Total Depth: -'LO <br />Drilling Rig Type:ti0� yG`V/ <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑ No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: IGb <br />To: S <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />- � height <br />.tiaovZ,�RcxrND c �szraox. <br />COM'1=f lON COMPLETION <br />Grc nd Sud;mc. <br />pr ut <br />#� A <br />Q <br />GROUTING or DESTRUCTION Total Depth: to, <br />Depth to Water:'` ta 44-. w ^ n - <br />Grout Material: <br />Gallons of Grout Used: "- YAO gA 0?'3 MATERIALS/DEVELOPMENT <br />Cas' T e <br />Nell Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �;fremie ❑Other: <br />Ing Yp <br />Blank 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 />Screen Feet <br />Bentonite/Gement Mix 3% Mix_ 5°f° Mix <br />k3entoniie per 47 Ib 1.41 1.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />Water <br />allons' <br />Cement 471b <br />Bas <br />Water <br />allons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />2,5 s <br />k Bags <br />1 <br />Thickest Thinnest <br />5 10 <br />9 Bags <br />1 <br />s <br />10 <br />2 <br />10 <br />20 <br />2 <br />7,5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />5 <br />15 <br />30 <br />6 <br />6 <br />17.5 <br />35 <br />7 <br />LiLso <br />7 <br />20 <br />40 <br />8 <br />8 <br />Ing Yp <br />Blank 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 />Screen Feet <br />Bentonite/Gement Mix 3% Mix_ 5°f° Mix <br />k3entoniie per 47 Ib 1.41 1.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />