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SAN JOAQUIN Environmental Health Department <br /> ---COUNTY— <br /> (;reotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Datern/ZK 5wzq Inspector:'Q _ CONSTRUCTION <br /> FacilityAddress: 3Uq ye e. <br /> Well Address: Total Depth: <br /> WP# Drilling Rig Type: <br /> Soil Drilling Min 2"Annular EHD Seal Verified: El Yes ONO <br /> Company: TE6 ' VI(�v8'Vlevan CalP�ywy <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Ccwgc4ce - f C'A- ► Filter Pack From: To: <br /> Geologist: L-Le lit t Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: El Yes ONO casing <br /> If yes, location and distance: Height <br /> SAMPLING ABOVE-GROUND cNRar`/-sox <br /> Holding Temperature: OOWLETIDN COMPLEMN <br /> Method: Gmnd s rfao. <br /> Screening Method: pran <br /> Verified Chain of Custody: ❑ Yes El No �N• <br /> N. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ONO <br /> If yes,spoils storage Location: <br /> slotted <br /> Covered: ❑ Yes ONO — wavel Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:S I ?•: = , <br /> Depth to Water: <br /> Grout Material: Vl�t� C�syse2n� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: cot if a s� Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation LBoring 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 KTremie ❑Other:, Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags allons Bags <br /> Thid:est Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 1 7 <br /> 20 1 40 80 1 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 />