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SANSJOAQUIN Environmen al Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> �i Monitoring Well/Soil Boring Inspection Report <br /> Date: O Z� Ins ector: CONSTRUCTION <br /> Facility Address: 2! 3S__bq <br /> Well Address: otal epth: <br /> WP# 0-0q-c* 3 Well#: 30r� 51� rilling Rig Type: <br /> Soil Boring#: VIC3o J 515 Min 2"Annular EHD <br /> S Seal Verified: El Yes ❑No <br /> Drilling Company: Z <br /> Driller Onsite: Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: 5 <br /> Geologist: c 1 } Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes III No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> OX <br /> Holding Temperature: COMPLETION CCOMPPLEMN <br /> Method: GroundSurtacs f <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> it. <br /> ft. <br /> SPOILS <br /> YT6 <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: <br /> slotted = 3 <br /> Covered: ElYes El No won <br /> -�.; ; •, praysl pad` <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 2;,C, _w <br /> Depth to Water: —A)4 , ft• — n• <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Nell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑B Slot Size: <br /> oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED vl o Bags Sand/Gravel: <br /> ,l 1 <br /> 51� Type/Brand of Bentonite: <br /> / <br /> 515 Pressure Grout Over Drill CrU <br /> / q Filter Pack Type/Size: <br /> S"Z ❑ Gravity �Tremie ❑Other: Type of Method: <br /> 53 Water Cement 471b Water Cement 941b <br /> I + gall Bags Ralillons Bags <br /> Thickest Thinnest tlBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 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 3s 70 7 <br /> 20 40 8 40 80 1 8 <br /> 10/16/2017 <br /> 1868 E. Hazeltl Avenue Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sicehd.com <br />