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SAN JOAQUIN Environmental Health Department <br /> " 1_-1:_ —COUNTY- <br /> Gieotness grows ht'ic. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: loL ?�� Inspector: (vicv-eLt CONSTRUCTION <br /> Facility Address: 7 j t 3 S, Lu.bftA.CrS yt,_� <br /> Well Address: ✓L -L I _ Total Depth: <br /> WP# 0 4_1AIL1 l Well#: grilling Rig Ty e: <br /> A Soil Boring#: l li5(r t- CSL t 6S , ( -6-':.t- i3� (-� `��i'r'�`r <br /> Drilling Company: w�r1-czar i-fit ,t-l5z.ff�3�5° � Aar EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: <br /> "-v� 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 .;'Rb COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 'VeKo casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION CC+APLEnON <br /> Method: aro nd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes E]No �ft• <br /> n. <br /> n. <br /> SPOILS - <br /> - _ <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: clotted <br /> section _ <br /> Covered: ❑ Yes ❑No = gr,,,s's <br /> If yes, material: '< r <br /> GROUTING or DESTRUCTION Total Depth: kV _ <br /> Depth to Water: 0- �.oaw��'^ n• n' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Loring Destruction Bags iz Cement: <br /> METHOD USED / Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest nBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 00 z 10 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 s0 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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />