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"`°, SANoJOAQUIN <br /> Environmental Health Department <br /> W o,`, Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: f /y1z3 Inspector: dt SMAI CONSTRUCTION <br /> Facility Address: /t=ye�arfCt✓�y� <br /> Well Address: —.1 Total Depth: <br /> WP# cy y.5' !Ez Well#:�G' Drilling Rig Type: <br /> Soil Boring#: I <br /> Drilling Company: wre a Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Driller Onsite: e ' Screen Length From: To: <br /> Consultant: l�<_r Filter Pack From: To: <br /> Geologist: Ifepea— 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: FIT height <br /> SAMPLING ABOVE-GROUND r <br /> IS <br /> ODNPLEr10N n4 <br /> CHRTYTTO <br /> Holding Temperature: cot=iErioN <br /> Method: Ground Suiaca r— <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �n. <br /> n. <br /> SPOILS — <br /> k�P — e <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: abnad ° _ s <br /> Covered: ❑ Yes ❑No 'I = <br /> cr+wl awk <br /> If yes, material: e <br /> GROUTING or DESTRUCTION Total Depth: 2-1/ <br /> Depth to Water: <br /> Grout Material: egt 1/j <br /> Gallons of Grout Used: f7�/y q14 Z7 I Z MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Lt•Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size:Boring Destruction 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 KTremie ❑Other: Type of Method: <br /> Water Cement471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest NBags Bentonite/Cement Mix 3°/aMiX 5%MIX <br /> 2.5 5 i 5 10 1 Bentonite er 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 1 2.821 4.7 <br /> 7.5 is 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> is 30 6 3D 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 8o 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />