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{ . <br /> IS, AN TJOAQUIN Environmental Health Department <br /> } ` " COUNTY <br /> Gr ,eotness grows here . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : �i �� Inspector : CONSTRUCTION <br /> Facility Address : �j- p�� sc�o✓ N <br /> Well Address : �; htiL� Total Depth : <br /> WP # �Q �1 �'V" Well # : _ Drilling Rig Type . <br /> Soil Boring# . tJf P Min 2 " Annular EHD Seal Verified : 41 Yes El No <br /> Drilling Company : � V.� � t,� _ <br /> Driller Onsite : NJ Screen Length From : ZS To : 10 <br /> — ' Filter Pack From : Zs To : <br /> Consultant : L1QZqke <br /> Geologist : Bentonite From : To : <br /> Grout From : Ton <br /> o : O <br /> Public Water System Onsite : Yes ❑ No COMPLETION ❑ Stove Pipe Christie Box <br /> Domestic Well Onsite : ❑ Yes No casing <br /> If yes , location and distance : height <br /> As W� <br /> SAMPLING AWVE-GROUNDff <br /> CO W LETION cHR�-sox <br /> Holding Temperature : COMPL >=nION <br /> Method : GrMi d S `� Of �� <br /> Screening Method . gt°"t r 1 <br /> Verified Chain of Custody . ❑ Yes ❑ No J� tto <br /> tt' <br /> �o ft. <br /> SPOILS <br /> r. <br /> m <br /> Contamination Noted : ❑ Yes ❑ No ` <br /> If yes , spoils storage Location : <br /> soon = : <br /> Covered : El Yes ❑ No „dpack <br /> If yes, material . 00 <br /> GROUTING Total Depth *. <br /> Depth to Water. <br /> Grout Material : ks <br /> Gallons of Grout Used : �: MATERIALS / DEVELOPMENT <br /> Casing Type : `pL '*\ . yc � <br /> Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> Slot Size : Q. <br /> El Boring Installation ❑ Boring Destruction Bags of Cement : <br /> METHOD USED Bags Sand /Gravel : <br /> Type/ Brand of Bentonite : <br /> ❑ Pressure Grout ❑ Over Drill Filter Pack Type/Size : ejwt= 3 SAV&Z ts <br /> �7 Gravity ❑ Tremie ❑ Other : <br /> Type of Method : <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rall ons Bags <br /> Thickest Thinnest it Bags Thickest Thinnest Bags Bentonite/Cement Mix 3 % Mix 5 % Mix <br /> 2. 5 5 1 5 10 1 Bentonite per 47 Ib 1 .41 2 .47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2082 4 . 7 <br /> 7, 5 15 3 15 30 3 <br /> I 10 20 4 20 40 4 <br /> 12. 5 25 5 25 50 5 <br /> 30 30 60 6 <br /> 1 , 5 35 7 35 70 7 <br /> 2D 40 $ 40 80 8 <br /> 10/ 16/2017 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 -34201 F 209 464 - 0138 1 www . sicehd . com <br />