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SAN JOAQUIN Environmental- COU NTY - ---- Health Department <br /> Greutness grows Caere . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : / hZ inspectora p r • CONSTRUCTION <br /> Facility Address : 2? (2 jl::55n !�- <br /> Well Address : Total Depth : <br /> WP # 4Well # : V Drilling Rig Type : ' <br /> Soil Boring# : <br /> Drilling Company : I � Min 2 " Annular EHD Seal Verified : ElYes El No <br /> Driller Onsite : Screen Length From : To : <br /> Consultant : C� L Filter Pack From : To : <br /> Geologist : Bentonite From : To : <br /> Jv <br /> Grout From : To : <br /> Public Water System Onsite : ❑ Yes ❑ No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes ❑ No <br /> casing <br /> If yes , location and distance : height <br /> SAMPLING w <br /> Af30YE-GROUND 1w <br /> -80X <br /> Holding Temperature : COMPLETION GtCC iAfS7Y LSTYTON <br /> Method : Ground surfacs <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes ❑ No ft . <br /> ft. <br /> SPOILS ft . — <br /> Contamination Noted : ❑ Yes ❑ No a <br /> — m <br /> If yes , spoils storage Location : = o <br /> $ to tad = <br /> Covered : El Yes Yes ❑ No = A. <br /> If yes , material : <br /> — 7X� Pack <br /> GROUTING or DESTRUCTI epth : <br /> --�Total D26 a. <br /> Depth to Water <br /> Grout Material : <br /> Gallons of Grout Used : MATERIALS/ DEVELOPMENT <br /> Casing Type : <br /> ❑ Well Installation XWell Destruction Blank Feet Screen Feet <br /> ❑ Boring Installation El Boring Destruction Slot Size : <br /> Bags of Cement : <br /> METHOD USED Bags Sand /Gravel : <br /> ❑ Pressure Grout ver Drill Type/ Brand of Bentonite : <br /> Filter Pack Type/Size : <br /> ❑ Gravity emie ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thic{: est Thinnest # Bads Thickest Thinnest Bags Bentonite/Cement Mix 3 % Mix 5 % Mix <br /> 2. 5 5 1 5 10 1 Bentonite per 47 Ib 1 . 41 2047 <br /> 5 10 2 10 zo z 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 5 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/ 16/ 2017 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 1 F 209 464 - 0138 www . sicehd . com <br />