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SAN J O A Q U I N Environmental Health Department <br />L COUNTY <br />Greotness grows here - <br />Monitoring Well/Soil Boring Inspection Report <br />Date: *712* 1 Inspector:rW3 <br />Facility Address: 7:1�6 41 UJ� kl�' �Ivd <br />Well Address: <br />WP# Z Well#: <br />Soil Boring#: <br />Drilling Company: _ <br />Driller Onsite: <br />Consultant: �— <br />Geologist: <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />.SPnll S <br />CONSTRUCTION <br />it <br />Total Depth: I2 <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: --- <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION ❑ Stove Pipe <br />casing <br />height <br />ABOVE -GROUND <br />COMPLETION <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />�<hristie Box <br />N./�t��� <br />r• <br />- <br />G mnd sufac. <br />proof <br />Contamination Noted: El Yes 11 No _tow <br />If yes, spoils storage Location: slotted <br />soon <br />Covered: ❑ Yes ❑No v N = c—+P v 6( <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: = I c�. <br />Depth to Water:`,,' <br />Grout Material: ` <br />MATERIALS/DEVELOPMENT S <br />Gallons of Grout Used: d now, <br />Lasing Type: s <br />tZpu <br />b.Jrc� b it \h h <br />VLWell Installation ❑Well Destructiono � � <br />I(j115 � n Feet Screen Feet <br />❑Boring Installation ❑Boring Destruction b'WlllbVY46t Size: <br />09n�1sr®IIb+°"1349s of Cement: <br />METHOD USED balaI,'L*0C')1t'►L' ags Sand/Gravel: <br />l k�.%31►1f1 + 41b' pe/Brand of Bentonite: <br />❑Pressure Grout ❑Over Drill 6L� 14 l� <br />filter Pack Type/Size: <br />Is I\ °i^I,` Type of Method: <br />❑ Gravity ❑Tremie ❑Other:�� <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />Rallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />RBags <br />Thickest Thinnest <br />ttBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <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 />25 <br />50 <br />5 <br />15 <br />30 <br />6 r <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 1 <br />B <br />40 <br />80 <br />8 <br />�n�'Ot�, ki 12.fh <br />Bentonite/Cement Mix 3% Mi 5% Mix <br />Bentonite per 47 Ib C 1.4 2.47 <br />Bentonite per 94 Ib 82 4.7 <br />\� look 1j b��Sj -k- <br />3"k t"J� <br />-3"ktrik�\ It .141b I ( tiiTIb .r f`'I <br />y• `j�?,��� I jy(� � }fib. h�1b c F �'�tir(, ._ <br />hemch IJP' wilib. –a 21b 10/16/2017 <br />l Kl 4►,7.}1b,— I <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 j"F� t209 V 0138 1 www.sicehd.com <br />