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SAN.sdOAQUIN p <br /> • � �� �"• Environmental Health Department <br /> —COUNTY— <br /> Greatness <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 5 Inspector:S UN tett CONSTRUCTION <br /> Facility Add ess: 11101 Brcvnkt W <br /> Well Address: Total Depth: <br /> WP# WP 0'p 3 !002� Well#: Drilling Rig Type: <br /> Soil Boring#: 'It 2 <br /> Drilling Company:_ VW - 1�1,L _ Min 2"Annular EHD Seal Verified: 11 Yes ❑No <br /> n <br /> Screen Length From: To: <br /> Driller Onsite: e <br /> Consultant: Iti11-t-2�dX Y, Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes 7)�No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes fANo casing <br /> If yes, location and distance: height <br /> SAMPLING A_BVE-GRCUntn <br /> c� <br /> cor�i.i=rtoly -ism-aox <br /> Holding Temperature: COMpLEnort <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Noy' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: siorad <br /> saC.'an — <br /> Covered: ElYes ❑No <br /> 9-V*Pack <br /> if yes, material: = _ <br /> GROUTING or DESTRUCTION Total Depth: ft <br /> Depth to Water: KO q(QIAJAJ 1A) n. IF <br /> ' <br /> Grout Material: N AP t Ct MI rj <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation E Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation IhBorling Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity %Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags _ <br />\`Q Thickest Thinnest #Bags Thickest Thinnest #Bags BentonitelCement Mix 3% Mix 5% Mix <br /> n� 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 I 3 , i <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 /> 1388 E. Hazelton Avenue I Stockton,Catifomia 95205 1 T 209 468-3420 1 F 269 464-0138 1 www.sicehd.com <br />