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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> , ,, Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: '114,202A Inspector:,S. IIIAMMAVDYIfAfq CONSTRUCTION <br /> Facility Address: SQAYOM QM-nyie Well Address: Igo 3.Dfgmom ' Total Depth: <br /> WP#24Cl(s1-t7_ Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: Cwwt <br /> DrillerOnsite: ,)\,tam'(3w Screen Length From: To: <br /> Consultant: \^ 1QS Tl°Gy)Mw g Filter Pack From: To: <br /> Geologist: )Ong Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes,location and distance: f� height <br /> SAMPLING ABOVE-GROUND <br /> CO&FLETION COMPLEn ON <br /> Holding Temperature: coMalFrioN <br /> Method: Ground Su fact T <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes ❑No tt• <br /> ft. <br /> SPOILS <br /> a <br /> Contamination Noted: ❑ Yes ONO <br /> If yes,spoils storage Location: rbttod ; <br /> "clon _ 3 <br /> Covered: ❑ Yes ❑No c . grawIack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: MI <br /> Depth to Water: tt• tt, <br /> Grout Material: IFt ('R,VY1eAnl MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 01II )l <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation)kBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity *remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> atlons Bags allons Bats <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cennent Mix 3%Mix 5% Mix <br /> 2.5 5 1 5 10 1 1 Bentonite per47lb I IIA111 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 1 2.821 4.7 <br /> is 15 3 15 30 3 - <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 5o 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 30 a <br /> 10/16/2017 <br /> 1868 E. Hazeiton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />