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SAN_J0A0IJIN <br /> Environmental Health Department <br /> —COUNTY— <br /> Greatness Grorrs ^ere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: l ';hX Inspector: CONSTRUCTION T <br /> Facility Address: SMt �`w 20 <br /> Well Address: Id Total Depth: 1 <br /> WP# a03jq-1 Well#: Drilling Rig Type: to 'j <br /> Soil Boring#:h 1, Q t , `2s .A'r , vS3 �1-1 I3 4 <br /> �T ��— 1 ` �jg�l/lin 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: '�.'r �W� <br /> Driller Onsite: (La b...,r�' <br /> Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑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 /> CO&PLE-rJON Crim I.N-BOX <br /> Holding Temperature: CL3kiP�TiON <br /> Method: c=rud Surras <br /> Screening Method: PR groLrt <br /> Verified Chain of Custody: ❑ Yes ❑No f' <br /> t <br /> ft. t. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> Covered: ❑Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> IF <br /> Depth to Water: (jj �� �--w " <br /> Grout Material: y fie, 6Z4 AT <br /> ��� MATERIAL /DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction I j -0 Blank Feet Screen Feet <br /> ❑Boring Installation ring Destruction brZ e I�C 5b5 Slot Size: <br /> 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 I�remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gall ons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest riBags Bentonite/Cement 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 J <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 209 468-34201 IF 209 464-0138 1 www.sicehd.com <br />