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SANGJOAQUIN <br /> Envir®nrnen Health Department <br /> •.�•.-= s. I —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:V(uT Inspector: se CONSTRUCTION <br /> Facility Address: 5 Cwvs.-t <br /> Well Address: Total Depth: <br /> WP# JUj $71e1 Well#:j,fl_:a> Drilling Rig Type: <br /> Soil Boring#: <br /> bb.r1, Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: (w S, aD <br /> Driller Onsite: Lg..v,S.l, Screen Length From: To: <br /> Consultant: (4,,.. 11_ce.. -{TB. L r,✓rwerl. Filter Pack From: To: <br /> Geologist: „ 1 kph' 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 casing <br /> If yes, location and distance: � height . <br /> SAMPLING ABOVE-GROUND <br /> COh1PLErwN CHRIM-80 . <br /> Holding Temperature: COIAPLET1oN <br /> Method: Ground IS <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes ❑Non. <br /> —n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = e <br /> If yes, spoils storage Location: x <br /> slottatl <br /> ssc5on kj <br /> Covered: El Yes ❑No gaval� <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:�y 1'5' <br /> Depth to Water: n. = n. <br /> Grout Material: ej4a- r cs &An4 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: � Casing Type: <br /> ❑Well Installation Rl ell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout L90 er Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity PTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gaill s Bags _ <br /> Thickest Thinnest Heags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 50% Mix <br /> 15 5 1 5 16 1 Bentonfle per 47 lb 1.411 2.47 <br /> 5 10• 2 10 20 2 Bentonfle per 94lb 2.821 4.7 <br /> 7.5 15 3 15 30 3 i <br /> 10 20 4 20 40 4 p. <br /> 115 25 5 25 50 5 6 / ,- <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 9 40 00 # <br /> iD l w �F Lot <br /> 1A7 6 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 /> to-)4W s'r 7 bas s It 11 <br />