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SAN 10A Q U I N Environmental Health Department <br /> " <br /> COUNTY <br /> Sys:: <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> , <br /> Date: ( 31 I Inspector: A0+S6-E#vv- CONSTRUCTION <br /> Facility Address: -735/ Gm«•E u�,4- Kd j- <br /> Well Address: Total Depth: <br /> WP#Or21d 86 Well#: Drilling Rig Type: DI?ADZ — o 7,6 <br /> Soil Boring#: B/�/Y,,/�17i J6 Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> 7u�•�cbK- <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 7Piraey— Filter Pack From: To: <br /> Geologist: &'3 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: IffT height <br /> 79-- —CrW-T <br /> SAMPLING A WVE-GROUND <br /> Holding Temperature: COWLEfION ccoowtFncN <br /> Method: °n"'ndS"rf"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No -�--n• <br /> n. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: atoned <br /> socdon <'! <br /> = B <br /> Covered: ❑ Yes ❑No = gI <br /> Pack <br /> If yes, material: < _ <br /> GROUTING or DESTRUCTION Total Depth: 2.0 = <br /> Depth to Water: I n• — n <br /> Grout Material: ALB* e-e^,o - MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Moring Destruction 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 &?Tremie ❑Other: Type of Method: <br /> Water 941911Water Cement 941b <br /> Ins t Bas gallons Bags <br /> Thickest Thinnest ags Thickest Thinnest NBags 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 ?o!i 3/ At74 AM, 4Lest <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 1/0 �7 `AIII 1,Z�3, �a S ZZ,-) 10/16/2017 <br /> 10/16/2017 <br /> (MT bads Z c99.1(" 1142.01868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 4FA 420 I F 209 464-0138 1 www.sicehd.com <br />