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SKJOAQUIN <br /> Environmental Health Department <br /> ".�•tI- COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:�-1(-X „q Inspector: 1 CONSTRUCTION <br /> Facility Address: ��[uiu Kam <br /> Well Address: Total Depth: <br /> WP# -2jfe011S1 Well#: MW -SJQ Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: C-aKAaeot.0-G <br /> DrillerOnsite: Aw.a4i Screen Length From: To: <br /> Consultant: r�L Filter Pack From: To: <br /> Geologist: Lt/iG/ Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes,location and distance: � height <br /> SAMPLING ABOVE-GROUND <br /> COWLEMN COX <br /> Holding Temperature: cotlplOMPL EMoN <br /> Method: Ground S <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑No �---tt <br /> SPOILSFE <br /> Contamination Noted: ❑Yes ❑No = ' <br /> If yes, spoils storage Location: _ s <br /> ,a <br /> Covered: ❑Yes ❑No action — <br /> MS� <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 20! <br /> Depth to Water: 7 t tt• — tt <br /> Grout Material: <br /> Gallons of Grout Used: lO cicittei—C MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> []Well Installation Nell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installationering Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> Npressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement941b <br /> allons Bags stations Bags <br /> Thickest Thinnest #Bags Thickest Thinnest NBags _ Bentonitelcement Mix 3% MIX 5%MN <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 1 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 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 />