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SAN JOAQUIN Environmental Health Department <br /> COUNTY— <br /> Greatness grows her,. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:4/-3-`11 Inspector: / CONSTRUCTION <br /> Facility Address: AJ3V /ror4�• <br /> Well Address: C/ Total Depth: <br /> WP# Z OO L AWell#: Drilling Rig Type: <br /> Soil Boring#: _/3 ' <br /> Drilling Company: GEry ..�G Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: rT h v✓ Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes []No casing <br /> If yes, location and distance: � height <br /> SAMPLING ABOVE-GROUND <br /> CONPLL7X3N COMPLETION <br /> Holding Temperature: cooN <br /> Method: amund Sunaae <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑No ---n• <br /> n. <br /> .—.n. <br /> SPOILS <br /> m <br /> Contamination Noted: ❑Yes ❑No ° <br /> If yes,spoils storage Location: slotted ;' <br /> Covered: ElYes El No section = 8 <br /> gravel Pads <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: L5i G1 <br /> Depth to Water: 3 9 —ft. n. <br /> Grout Material <br /> Gallons of Grout Used: // Jy 14-j; Ad'2r ( MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Slot Size: <br /> Bags Destruction 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 KTJremie ❑Other: Type of Method: <br /> Water Cement471b Water Cement 941b <br /> allons Bags eallons Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest °Balls BentonitelCernent Mix 3% Mix 5e/a Mix <br /> 2.5 5 1 s 10 1 113entonite per47lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 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 15 50 5 !/ /� ate,, <br /> 15 30 7 30 60 6 J/Grn • /J.'['/`L�/��i.✓/�' <br /> 17.5 35 7 35 <br /> 20 40 1 3 1 40 60 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 />