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SAN�JOAQUIN <br /> COUNTv Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Zs "Z/ Inspector: /LAS f-r-[M CONSTRUCTION <br /> Facility Address: k900 wred 4a d <br /> Well Address: Total Depth: <br /> WP#00 qw/ Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company:Com an /aa Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> �� <br /> Driller Onsite: ✓" t Screen Length From: To: <br /> Consultant: -rood C Filter Pack From: To: <br /> Geologist: T-O/i x 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 ABOVEGROUND <br /> COWLETION COMPLETION <br /> BON <br /> Holding Temperature: cornP11T1oN <br /> Method: Gmuncl surl&c. <br /> Screening Method: GrIoot <br /> Verified Chain of Custody: ❑ Yes ❑No :S�#• <br /> (t. <br /> SPOILS V�'�i 2. <br /> Contamination Noted: ❑ Yes ❑No <br /> e <br /> If yes,spoils storage Location: 1(%,61? ' __ s <br /> slotted <br /> &action <br /> Covered: ❑ Yes ONO _ pad, <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite; <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water 471b Water Cement 941b <br /> allons I Ba s gallons Bags _ <br /> Thickest Thinnest #Bags Thickest Thinnest 9Bags _ Bentonite/Cement Mix 3% MIX 5/. MIX <br /> 2.5 a 1 5 10 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 1 2821 4.7 <br /> 7.5 15 3 15 30 3 - - <br /> 30 20 4 20 40 4 r <br /> 12.5 25 5 25 so 5 ttal he jow s'/F 40-C p ;r7'(t 4me" <br /> 15 30 B 30 60 6 rC�y�- <br /> 1 <br /> 37.5 35 7 35 70 7 �t''J/fsp�1.4/)� A"^/d-'1v7 <br /> 20 1 40 B� 40 00 1 0 <br /> 10/16/2017 <br /> 1868 E. Haz ((to``nn __Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />