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SAN�JOAQUIN <br /> COUNTY— Environmental Health Department <br /> twoes!% Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: "Ir-707V Inspector: AAevl"+ CONSTRUCTION <br /> Facility Address: .f7Gw w• 4Jret ulaa <br /> Well Address: Total Depth: <br /> WP#AQ z/ZoiS Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company:62aea de Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Driller Onsite: i Y Screen Length From: To: <br /> Consultant: To"Aur Filter Pack From: To: <br /> Geologist: OA=A6 A 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 <br /> casing <br /> If yes, location and distance: nas9he <br /> SAMPLING ABOVEGROUND <br /> Holding Temperature: COMPLETION CHRM'-BOX <br /> COMPLETION <br /> Method: G=nd Swfaca�__ <br /> Screening Method: Aran <br /> Verified Chain of Custody: ❑Yes El No tSu N`"I"ie tnta l —tt <br /> ,� utlu� ,.seCls• tt. <br /> SPOILS pp�� <br /> & b e ' <br /> Contamination Noted: ❑ Yes ❑No a, <br /> If yes,spoils storage Location: <br /> SdE- 3� b stodad `'i _ <br /> Covered: ❑Yes No sicdon lei _ 8 <br /> psi gravel Pads <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: _ <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <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 /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall Bags allons Bags <br /> Thickest Thinnest kBags Thickest Thinnest HBags BentonitelCement Mix 3% MIX 5%MIX <br /> 2s s 1 s to 1 I Bentonite per 47 Ib 1.411 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 lb 2.821 4.7 <br /> 7.5 is 3 15 30 3 <br /> 10 20 4 20 40 4 ��t/i� S�Wt ?'0*4'r <br /> 25 50 5 <br /> 12.5 25 5 4T�1'✓�Ci`.� <br /> 15 30 6 30 60 6 •1<0�������F��/a, �� ���, O0 <br /> 17.5 35 7 35 70 1 7 20 40 8 140 BO 8 — s✓/_� 3 �t�i'1�/e�aaa/./ arp�j�//o' <br /> e ��✓ ��� /w ( / 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3✓420 1 F 2t0�9 464-0138 1 www.sicehd.com <br />