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SAN JOAQUIN Environmental Health Department <br /> —COUNTY-- <br /> Greutness groves here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: /Zq <br /> / O j t7 I-nlspector: CONSTRUCTION <br /> Facility Address: `� `7 �' �' "r <br /> Well Address: Total Depth: � <br /> WP# Well#: � � �" I(� Drilling Rig Type: S <br /> Soil Boring#: -40 'Min 2" Annular EHD Seal Verified: El Yes ❑Nb" <br /> Drilling Company: ' �� G I ��D "�vIScreen Length From: To: <br /> Driller Onsite: E <br /> Filter Pack From: To: <br /> Consultant: <br /> Bentonite From: To: <br /> Geologist: C <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: Tff T height <br /> 14 w— —CwT <br /> SAMPLING ABOVE-GROUND c4-St'43Ox <br /> H COMPLETION COMPLETION <br /> Holding Temperature: <br /> Ground Sudacs <br /> Method: <br /> grout <br /> Screening Method: <br /> ft. <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. _ <br /> SPOILS — <br /> Contamination Noted: �,�� [X4es ❑No = <br /> r tw <br /> v4 ; <br /> If yes, spoils storage ocation: � 6 .lod <br /> S� "�` ✓V� C "cdon <br /> ❑ ❑N o Q� — voi P <br /> �es � I — cnPackCovered. � -� —_ <br /> If yes, material: — <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: ' MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: A' Casing Type: <br /> ❑Well 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 L(Over Drill Filter Pack Type/Size: <br /> ❑ Gravity Izremie ❑Other: Type of Method: <br /> Water //Cement 471b Water Cement 941b <br /> allons Bags allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5% MIX <br /> z.s s 1 s 10 1 Bentonite per 47 lb 1.41 2.47 <br /> s 10 z 10 20 2 Bentonite per 94 Ib 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 so 5 <br /> 15 6 30 60 6 <br /> (;v� 17.5 35 7 35 70 7 <br /> `� zo 40 4o ads go I 10/16/2017 <br /> \o � ` <br /> hLiiAc��h cUI,G! <br /> V 1868 E. Hazelton Avenue I Stock n, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />