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Z10 SANsJOAQUIN <br /> COUNTY - Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: `� I$ Ins ector: CONSTRUCTION <br /> Facility Address: ? ��( ( <br /> Well Address: # Total Depth. <br /> WP# 0 0 t E ool 3 Well#:- y-3 bC� Drilling Rig Type: <br /> Soil Boring#: �J1 <br /> Drillin Company: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> g p Y� � �V c/_ _ <br /> Driller Onsite: -A,,x '-e t 4 4 Screen Length From: To: <br /> Consultant: C Cly, I _ ��- 3Filter Pack From: To: <br /> Geologist: cL c Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No ►COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No ��' L casing <br /> If yes, location and distance: ___ f f height <br /> Yoh 10 �X <br /> t 3 od,SAMPLING m '- <br /> ►J",' 80VE-GROUND CHRISTY-BOX <br /> Holding Temperature: _ �yv-r5 co16Pt.l TION cOMPtEncN <br /> Method: °r°"n°S"i"" <br /> 1^Screening Method: �� grout <br /> .L� <br /> Verified Chain of Custody: El Yes ❑No ft.�Y� <br /> tt. <br /> ft. <br /> SPOILS '. <br /> 1 � <br /> Contamination Noted: _ ❑ Yes ❑No `� <br /> If yes, spoils storage Location: .Iry s{ottaO K <br /> iiLL(( <br /> "(Jai sac9on <br /> ❑ = B <br /> Covered: ❑ Yes No gravel pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> e <br /> Grout Material: J <br /> Gallons of Grout Used: 6MATERIALS/DEVELOPMENT <br /> .Otrtch Casing Type: <br /> ❑Well Installation Well Destruction vJ,,,L.S Blank Feet Screen Feet <br /> \ �u4-flilldSlot Size: <br /> El Boring Installation El Boring Destruction terA��.y Bags of Cement: <br /> METHOD USED 5�( Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ���Pressure Grbu Over Dill Filter Pack Type/Size: <br /> ❑ Gravity Oremie ❑Other: , Type of Method: <br /> So. C r <br /> Water Cement47lb Water Cement 94lb <br /> allons Bags gallons Bags <br /> Thickest Thinnest tlBags Thickest Thinnest uBags Bentonite/Cement Mix 3% MIX 5% MIX <br /> 2.5 5 1 5 10 1 � Bentonite per 47 1b 1.41 2.47 <br /> 5 10 2 10 20 2 W Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 �5 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 a Y a,J <br /> 17.5 35 7 35 70 7 <br /> . 200 40 8 40 80 8 <br /> -U �U 'Z-3 bLjs 3-Lb © S d GL� 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 />