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? 1 SANJOAQUIN <br /> COUNTY -t< Environmental Health Department <br /> Greatness grows herr <br /> I l Monitoring Well/Soil Boring Inspection Report <br /> Date: l to Inspector: (.,-LJTar�t CONSTRUCTION <br /> Facility Address: l j!f1� ,E ?' r ( ma 4--cm <br /> Well Address: ' Total Depth: <br /> WP# D U °l Well#: Drilling Rig Type: <br /> Soil Boring#: 6w <br /> Drilling Company: ' o� y 0 1.t,L Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: ((,r'rA�^c��r�nc_ Cva �,•rrow67 Filter Pack From: To: <br /> Geologist: "� � Z — Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes �-,bNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑INlo --rr-- casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLErJON COOMPLET10N <br /> Method: GnxirdSurf ac* T <br /> Screening Method: grotA <br /> Verified Chain of Custody: ❑ Yes ❑No Ott. <br /> tt. <br /> -ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ;ZINC) <br /> If yes,spoils storage Location: stortad <br /> a*cdcn <br /> Covered: ❑ Yes ❑No = 9,,,W Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: t tt' <br /> Grout Material: e <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 0,�� <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Coring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity IlTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> gall s Bas Rations Bags <br /> Tq0esj Thinnest ueags Thickest Thinnest pBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> z. 5 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 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 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 Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />