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SQNcJOQQUIN Environmental Health Department <br /> r. { _ —COUNTY- <br /> °qt FoayP Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1°!17/18 Inspector: /✓a.f ee., - CONSTRUCTION t <br /> Facility Address: /Lct- hr ys f 10,5.0 � L� Dr jJ fes' <br /> Well Address: Total Depth: f"0 I <br /> WP# CSD 3fSfSy Well#: Drilling Rig Type: <br /> Soil Boring#: 6/3 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: '✓, <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COf"FLETION COMPLETION <br /> Method: Ground Surf"' If <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes []No <br /> if yes, spoils storage Location: abnod <br /> section <br /> Covered: ❑ Yes ❑No = 1xXV'W Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 7 " n <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation Agoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity PS-Tremie ❑Other: Type of Method: <br /> ate ent 4 Ib Water Cement 941b <br /> al Bas valill ons Bags <br /> Thickest Thinnestags Thickest Thinnest #Bags 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 <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 /> 30 /1 ,rr'X ✓sem -60 or,'A-R-8✓3.04 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />