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SQNJOQQUIN Environmental Health Department <br /> COUNTY- - <br /> _. i� rc:re;s gross <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: iA11_bV Inspector: CONSTRUCTION <br /> Facility Address: Z.Nq(o66 S. 1-6iNspgt IZ4 <br /> Well Address: Total Depth: <br /> WP# 12Y) 6475' Well#: Drilling Rig Type: <br /> Soil Boring#: 13/ *i/y✓3 k Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company:V W <br /> Driller Onsite:�J le <br /> Screen Length From: To: <br /> Consultant:_k j el'k 4-1d Pr, t.c-C Filter Pack From: To: <br /> Aa " From: To: <br /> Geologist: �Q <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 /> Holding Temperature: COMPLETION COMPt.EMN <br /> Method: Ground Sumacs <br /> Screening Method: 1 grout <br /> — <br /> �� <br /> Verified Chain of Custody: El Yes ❑No 61; Z���Lt tt' <br /> tt. <br /> SPOILS Pjs�(d7 Z� tt <br /> 9,IDi1�i7� Zo = e <br /> Contamination Noted: ❑ Yes ❑No = r <br /> If yes, spoils storage Location: �►3�1`l 1�� .toga <br /> /s g asc'on = B <br /> Covered: ❑ Yes ❑No = � <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: Ab G+49 tt tt. <br /> Grout Material: * <br /> C_er'ne_w <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <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 /> (Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity QTremie XOther: 1%/Ve4ll Type of Method: <br /> Wate nt 71 water Cement 941b <br /> all Bas gallons Bags <br /> Thickest Thinnestags Thickest Thinnest 4Bags BentonitelCement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 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 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />