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SANJOAQW) Environr itap Health Departmont <br /> —.Z-0 U N TY— - <br /> Greatness groves here. <br /> i Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: _ CONSTRUCTION <br /> Facility Address: ?,Woa MRw Sc- <br /> Well Address: 4 L° sTyy�' S Total Depth: <br /> WP# Oot{ O -10\1 Well#: MuJ Drilling Rig Type: <br /> Soil Boring#: tJ JA Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: %.\\ - "-i l otK) A� <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: \wk\0u �' v, �. Filter Pack From: To: <br /> Geologist: QvC Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: N� ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes WINO casing <br /> If yes, location and distance: haLght <br /> SAMPLING ABOVE-GRCUND rrla>srreox <br /> Holding Temperature: Cot>irLEnON cbA4PtEroN <br /> Method: ar°" as`era <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No tt- <br /> i#. <br /> SPOILS <- <br /> � '.. <br /> Contamination Noted: Yes ❑No o <br /> Tt •- o <br /> If yes, spoils storage Location: LO\g,o MREW 6T • arynaa c7EE <br /> a sstdan � _ -a <br /> Covered: 5-yes ❑No _ —1 P-K <br /> If yes, material: C �� � <br /> GROUTING or DESTRUCTION Tota Depth: S� 7 I _ :•. <br /> Depth to Water: n' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation El Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity gTremie ❑Other: Type of Method: <br /> MWaterCement 47hb Water CementMlb <br /> Ba ellonse#Bags Thickest Thinnest #8ags _ Bentonite/CementMix 3% Mix5% M1x <br /> 1 Mtn 10 Bentonite er 47 1b 1.41 2,47 <br /> 2 10 2D Bentonite er 94 Ib 2.82 4.73 15 30 3 4 20 4D 4 <br /> 115 25 5 25 50 5 . <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 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 />