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SAN IOAQUIN <br /> Environmental Health Department <br /> + Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: (46)'262K Inspector:5"T)' In MoV �0 CONSTRUCTION IA A <br /> Ir <br /> Facility Address: 5@INe S. 6rporT ld,Al , k) t Z W Phil <br /> Well Address: Total Depth: 5D <br /> WP# uj 0(puyy Well#: Mw r Drilling Rig Type: Kiu <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: I�Yes ❑No <br /> Drilling Company: �, <br /> Driller Onsite: MiK, Screen Length From: To: 3 <br /> Consultant: S � +i Filter Pack From:_ To: <br /> Geologist: Bentonite From: To: <br /> Grout From: 21; To:— <br /> Public Water System Onsite: ❑ Yes No COMPLETION ❑ Stove Pipe /&hristie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> T <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: coMPLErl°N cOMPLEMXi <br /> Method: Grwnd SWaos t <br /> Screening Method: grout I <br /> Verified Chain of Custody: ❑ Yes ❑No _ Z�►, t � <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: _ p <br /> sbttad _ � <br /> aacdon = � <br /> Covered: ❑ Yes ❑No = ,:w <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: IF <br /> Depth to Water: 6-64� tL n <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ,<Nell Installation ❑Well Destruction 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 /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> I�Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Bags gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest 4Bags 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 25 5 25 50 5 <br /> 15 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 />