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SAN JOAQUIN Environmer,cal Health Department <br /> Greatness grows here. <br /> /ZpI� Monitoring Well/Soil Boring Inspection Report <br /> Date: 1 i (q Inspector: CONSTRUCTION <br /> Facilit Add ess: 3139 A <br /> Well Address: I Total Depth: I C(� <br /> WPfi WeIIN: l/µ 1Z Drilling Rig Type: H,5 <br /> Soil Boring#- Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: a " <br /> Driller Onsite: y' Screen Length From: To: <br /> Consultant: Filter Pack From: .�3 To: �z <br /> Geologist: Bentonite From: D To: <br /> Grout From: To: Z a <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO oaoing <br /> If yes, location and distance: na,>.yhe I <br /> SAMPLING ABOVEGROUND CHRi W43OX <br /> Holding Temperature: COWLErloN CCMPLETiON <br /> Method: Grounds o"' —f---- <br /> Screening Method: grout <br /> Verified Chain of Custody: n. <br /> ❑ Yes ❑No tt <br /> . SPOILS —ft. <br /> Contamination Noted: ❑ Yes ❑No , =_ <br /> If yes,spoils storage Location: ' <br /> ebttad 1 = <br /> soction <br /> Covered: ❑Yes ONO = g-vWpack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: 3 t7 =_ <br /> Depth to Water: <br /> Grout Material: Aye"tr Grcx_J <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT n /� <br /> Casing Type: �"y <br /> Well Installation ❑Well Destruction Blank 3�Feet Screen Z'O Feet <br /> Slot Size: 60(0 <br /> ❑Boring Installation ❑Boring Destruction <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 94lb <br /> allons Bags irallons Bags <br /> ThickestAThinnest #Bags Thickest I Thinnest #Bags _ Bentonite/Cement Mix 3% Mix 5%Mix <br /> as I= 5 1 5 10 1 Bentonite per47lb 1.411 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 lb 2.821 4.7 <br /> 7.5 15 3 15 30 3 , <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 1 30 6 30 60 6 <br /> 17. 35 35 70 7 <br /> 2 40 B 40 00 B <br /> Note : '(pert A(5 Awl Pkh red 5 r6 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 />