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SAN 1OAQUIN Environme al Health Department <br /> COUNTY— <br /> Greatness yrows here . <br /> Monitoring Well /Soil Boring Inspection Report <br /> Date : `�O t �Z1 Inspector : CONSTRUCTION <br /> Facility Address : Oi"Z-� <br /> Well Address : LC!Z �c11�'1` - --�pr` l . Total Depth : <br /> WP# `wkeL ZIS Well # : � Drilling Rig Type : <br /> Soil Boring# : _T� � Min 2" Annular EHD Seal Verified : ❑ Yes ❑ No <br /> Drilling Company : <br /> Driller Onsite : Q-� � �r�C Screen Length From : To : <br /> Filter Pack From : To : <br /> Consultant : <br /> Geologist : W\(�� M";Zw Bentonite From : To : <br /> Grout From : To : <br /> Public Water System Onsite : //Yes ❑ N COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : El Yes No casing <br /> If yes, location and distance : height <br /> �(W' T <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature : CONFLETION cCOMP0N <br /> Method : Groundsurta" + <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes ❑ No ft' <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted : ❑ Yes ❑ No V — <br /> If yes, spoils storage Location : sto"d yµo <br /> saaion <br /> Covered : ❑ Yes ❑ No :w" _ smf pack <br /> If yes, material : . <br /> GROUTING or DESTRUCTION Total Depth :_ - <br /> Depth to Water : $_ ) <br /> #t. = ft• <br /> Grout Material : C. *'E! �tJ'� <br /> `��• \ o � Qa, Q MATERIALS / DEVELOPMENT <br /> Gallons of Grout Usecl : <br /> Casing Type : <br /> ❑ Well Installation Well DestructiQry Blank Feet Screen Feet <br /> Slot Size : <br /> ❑ Boring Installation ❑ Boring Destruction Bags of Cement : <br /> METHOD USED Bags Sand/Gravel : <br /> Type/ Brand of Bentonite : <br /> El Pressure Grou/Tremie <br /> ver Drill Filter Pack Type/Size : <br /> 11 Gravity ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bays <br /> Thickest Thinnest taBags Thickest Thinnest # Bags Bentonite/Cement MIX 3 % MIX S % MIX <br /> 2. 5 5 1 5 10 1 Bentonite per 47 Ib 10411 2 .47 <br /> s 10 z 10 20 z Bentonite per 94 Ib 20821 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 70 7 <br /> 20 40 40 80 8 <br /> 10/ 16/2017 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468 -3420 F 209 464- 0138 1 www, sicehd . com <br />