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SAN JOAQUIN Environmental Health Department <br /> COUNTY - <br /> `Fj, F,+sP! Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:-7--1 Inspector: CONSTRUCTION <br /> Facility Address: /CSrds! (CppeNjN111 2d I2Dl <br /> Well Address: Total Depth: C C <br /> WP# Z`{ zo Well#: mw"1 Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: e adr a B Min 2"Annular EHD Seal Verified: ,Yes ONO <br /> Driller Onsite: �q�v,a r Screen Length From: JZ,0 To: /00 <br /> Consultant: cr •fool of s Filter Pack From:_12-0 To: _qS <br /> Geologist: LQrso.✓ Bentonite From: `6 To: 4(0 <br /> Grout From: To: Jr <br /> Public Water System Onsite: ❑Yes ONO COMPLETION ❑ Stove Pipe Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes,location and distance: � height <br /> SAMPLING ABOVE-GROUND <br /> COWLS ION COMPLETION <br /> Holding Temperature: cor•+rt.ErioN <br /> Method: Ground S <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —tt• <br /> ft. <br /> SPOILS <br /> Yc <br /> Contamination Noted: El Yes ONO <br /> If yes,spoils storage Location: ' <br /> .lonad <br /> arrcdon rl Covered: El Yes ONOEE_ graval peck <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tt• — tt• <br /> Grout Material: Nu C•e MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: p✓G .S(�A KD <br /> ❑Well Installation ❑Well Destruction Blank 100 r Feet Screens Feet <br /> �$oring Installation ❑Boring Destruction Slot Size: '02-0 <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Vd? <br /> Filter Pack Type/Size: -W /z <br /> ❑ Gravity �remie ❑Other: Type of Method: poy <br /> Water 2gment471h water Cement 94lb <br /> allons vallons Bairs <br /> Thickest Thinnest 9Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% MIX 5% MIX <br /> 2.5 s 1 5 10 1 Bentonite per47lb 1 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 lb 1 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 50 5 <br /> 15 30 6 % 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 3 40 40 8 <br /> 6-y P'*r h@ss us+cl'• 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 />