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S A N JOAQUt Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> �J Monitoring Well/Soil Boring Inspection Report <br /> Date:/ D Inspector: b�� C CONSTRUCTION <br /> Facility Address: �q,2� (u S <br /> Well Address: r 61 otal Depth: IJ <br /> WP# j Well#: 0 (FA Drilling Rig Type: <br /> Soil Boring#: �in 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: Screen Length From: To• <br /> Driller Onsite: nc, <br /> a <br /> Filter Pack From: To <br /> Consultant: Bentonite From: To: <br /> Geologist: Grout From: To <br /> Public Water System Onsite: ❑Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO aaaing �� I o.Lij. <br /> height <br /> If yes,location and distance: s$JI <br /> to, G <br /> SAMPLING ABOVE•GROUNOq + P^ �crwlsrreoxq' �� <br /> COMPLETION .� COMPLETION 1 <br /> Holding Temperature: F,a a <br /> Method: r1A sa /0'S �Y <br /> Screening Method: 1os groom $ <br /> i i`� n.pr <br /> Verified Chain of Custody: El Yes ❑No <br /> SPOILS — e <br /> ❑ Yes ONO <br /> C3 # 51 r = o <br /> Contamination Noted: — <br /> Ti =Location:storage oils es, � l <br /> If Y P g s lo� dotted Z i = <br /> � #4cIon <br /> Covered: El YesONO <br /> //� = gi pack— <br /> If yes,material: f� <br /> GROUTING or DESTRUCTION Total Depth: a _ <br /> tt. <br /> Depth to Water: �24 Praks ��— �@ <br /> Grout Material: C$rkyA MATERIALS/DEVE OPMENT <br /> Gallons of Grout Used: I � Casing Type: <br /> ❑Well Installation ❑Well Destruction t0 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 /> ❑ Gravity ❑Tremie ❑Other: <br /> Type Of Method: <br /> Water Cement 471b Water Cement941b <br /> allons Be s allons Oa s <br /> Thtdrest Thinnest #Bags Thickest Thinnest #Bags BBntonitelCement Mlx 3"/e Mix 5%Mix <br /> 75 5 1 5 to 1 Bentonite er 47 lb 1.41 2.47 <br /> 5 to 2 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 - <br /> 10 20 4 20 40 4 <br /> 17.5 25 5 2 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 1 40 s 40 90 B 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 />