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' ,'• SAN JOAQUIN Environmental Health Department <br /> _ Grc°Ine55 grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Ad r ss: ^_F � � <br /> Well Address: Total Depth: <br /> WPH IMOOMQ WeII#: I�,IA�I f I�G( Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑NO <br /> Drilling Company: M Screen Length From: To: <br /> Driller Onsite: A'h nq <br /> Consultant: GDodor Filter Pack From: To: <br /> Geologist: (,Vv-P. <br /> 6ttb""J' <br /> Bentonite From: To: <br /> i I-Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO 66�'CO PLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO 5j 93 casing <br /> If yes, location and distance: pq�v'���y��✓ height <br /> du�tirvlut� <br /> SAMPLING Vt+� JJ EVE-GROUNDCHRIM 43Ox . <br /> Holding Temperature: 4 COLPI-ETION COMPLETION <br /> V15t Method: Ground su lacy <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No --n' <br /> n. <br /> SPOILS <br /> e <br /> Contamination Noted: ❑ Yes ONO <br /> If yes, spoils storage Location: 6I0 _ a <br /> Covered: ❑ Yes ❑No gravel P-X <br /> If yes, material: <br /> x = <br /> GROUTING or DESTRUCTION Total Depth: GO 1 <br /> Depth to Water: ZI <br /> Grout Material: N t <br /> Gallons of Grout Used: �+ MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction 11215 Blank Feet Screen Feet <br /> v '" Slot Size: <br /> ❑Boring Installation ❑Boring Destruction 4- Bags of Cement: <br /> METHOD USED ZZ�ixd�5 Bags Sand/Gravel: <br /> ❑Pressure Grout Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Ba s <br /> Thickest Thinnest s Thickest Thinnest aeags Bentonite/Cement MIX 3°/a Mix 5% MiX <br /> 2.5 s 1 s 10 1 Bentonite er471b 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 is 3 15 30 3 <br /> t0 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 00 0 <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 />