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N �G SAN JOAQUIN <br /> Environmental Health Department <br /> COU NTY <br /> `L �% Greatness grows here .Fo <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : 34W17e Inspector : A0OW400011C <br /> t6� CONSTRUCTION <br /> Facility Address : 66094 �� <br /> i� /2. ' � <br /> Well Address : Total Depth , <br /> WP #cap �// �7 / / Well # . Drilling Rig Type : <br /> Soil Boring# : .l`- OP — / g Min 2 " Annular EHD Seal Verified : ❑ Yes [] No <br /> Drilling Company : ecq jtewle <br /> : Screen Length From : To : <br /> Driller Onsite <br /> Consultant : S' Filter Pack From , To . <br /> Geologist : of Bentonite From : To : <br /> Grout From : To . <br /> Public Water System Onsite : ❑ Yes El No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes ❑ No casing <br /> If yes , location and distance : height <br /> SAMPLING ASOVE-GRCCNID _ <br /> Holding Temperature : CO ' � �ON COMPLETIOCHRLS7YN <br /> Method : G= r)d Surfaces <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes ❑ No — ft ' <br /> He <br /> ft. <br /> SPOILS = <br /> Contamination Noted : ❑ Yes ❑ No — <br /> If yes , spoils storage Location : stoned ` _ <br /> sac�en — <br /> Covered : ❑ Yes ❑ No <br /> If yes , material : < `— <br /> �w: <br /> GROUTING or DESTRUCTION Total Depth : ! s =- <br /> Depth to Water : 5% ,5�� ft• �` n ' <br /> Grout Material : /?/e rev'Oy ,. <br /> Gallons of Grout Used : Z eeomi MATERIALS / DEVELOPMENT <br /> Casing Type : <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> ❑ Boring Installation OBoring Destruction Bags of Cement : <br /> METHOD USED Bags Sand / Gravel , <br /> Type/ Brand of Bentonite : <br /> ❑ Pressure Grout ❑ Over Drill Filter Pack Type/Size : <br /> ❑ Gravity ❑ Tremie ❑ Other : Type of Method : <br /> Water Cement 471b Water Cern ent 94 lb <br /> gallons Baas rtallo is Baas <br /> Thickest Thinnest M Bags Thickest Thinnest :t Baas <br /> Bentonite/ Cement Mix 3 °fo Mix 5 % Mix <br /> 2 . 5 5 1 5 10 1 Bentonite per 47 Ib 1 . 41 2047 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2 . 82 4 . 7 <br /> 7, 5 15 3 15 1 30 3 <br /> 10 20 4 20 40 4 <br /> 115 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17. 5 35 7 35 70 7 <br /> 20 40 ° 40 "00 3 <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 />