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I <br /> SAN_JOAQUIN Environmental Health Department <br /> N <br /> :L•Ji' ,' `f —COUNTY_..._ <br /> `•°��, P' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:1 /f', Inspector: S l�a CONSTRUCTION <br /> Facility Address: M � .C�1' <br /> S• Eb � e"-,�I U"V) <br /> Well Address: Total Depth: <br /> WP#hs a4FL Well#: '?j Drilling Rig Type: <br /> Soil Boring#: <br /> p v�� rnQ DWI <br /> 2" Annular EHD Seal Verified: El Yes ❑No ' <br /> Drilling Company: 1U-�W4I w0a"�� <br /> Driller Onsite: Screen Length From: To: <br /> - <br /> Consultant: ,IlilX Filter Pack From: To: <br /> Geologist: }L Bentonite From: To: <br /> Grout From: To: <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: T height <br /> 79 <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION cCW1_ CN <br /> Method: Gnwnd Surf ace <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> tt. <br /> tt. <br /> SPOILS <br /> = o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted <br /> tacon — <br /> Covered: ❑ Yes ❑No <br /> If yes, material: ;: <br /> GROUTING or DESTRUCTION Total Depth:_ <br /> Depth to Water: <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> �1 Casing Type: <br /> ❑Well Installation well Destruction ���� w1� Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction "�� 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 114Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Bags Fallons Bags <br /> Thickest Thinnest pBags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 35 5 25 50 5 <br /> 155 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />