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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> . Greatness grown here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Iq Inspector: (IngImYVYAIIA�G'SGI CONSTRUCTION <br /> Facility Address: ���0 �. �iG.3�ii-nv� 1tyel <br /> Well Address: Total Depth: <br /> WP#?.L6@N@6&L-1 Well#: MW_�I Drilling Rig Type: <br /> Soil Boring#: l AW ` m Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: Vf' W <br /> Driller Onsite: f-e Screen Length From: To: <br /> Consultant: I Im y, wan Filter Pack From: To: <br /> Geologist: �-tAGIdy 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 —QW7:F <br /> SAMPLING ABOVEGROUND <br /> COWLEfION COMPLETION <br /> Holding Temperature: cotnriErioN <br /> Method: Gmna suiac0 <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> tt. <br /> SPOILS rt <br /> Contamination Noted: ❑ Yes ❑No = '` <br /> If yes,spoils storage Location: <br /> �btted s = 3 <br /> Covered: ❑Yes ❑No ao�an fi = <br /> vravalvck <br /> If yes, material: <br /> �I 1 <br /> GROUTING or DESTRUCTION Total Depth: , <br /> Depth to Water: — tt. = ft. <br /> Grout Material i- e l` MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ^1 Zt OallUvO Casing Type: <br /> ❑Well Installation .Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <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 remie ❑Other. Type of Method: <br /> Water Cement 471b Water Cement941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest aBags Bentonite/Cement Mix 3% MIX 5%MIX <br /> 2.5 5 1 5 10 1 Bentonite per 471b 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 /> 10 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 B 40 00 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 />