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SANAAQUIN <br /> COUNTY— <br /> Environmental Health Department <br /> s '=•' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> (fi <br /> Date:12. (I rb Inspector: r CONSTRUCTION <br /> Facility Address: 3 O(ub M <br /> Well Address: _ ! Total Depth: <br /> WP# DIZV 5 Well#: Drilling Rig Type: _ <br /> Soil Boring#: 2F 0 <br /> Drilling Company: G'leA Min 2"Annular EHD Seal Verified: L1 Yes ❑No <br /> Driller Onsite: OI,W Screen Length From: To: <br /> Consultant: • lEGO Filter Pack From: To: <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 AWVS. RSD <br /> Holding Temperature: cowLETrort coaaPt FTiorXt <br /> Method: <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No f- <br /> ft. <br /> fi. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No - o <br /> If yes,spoils storage Location: storsd <br /> Yi o C <br /> sac5on } <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: e&T ccwe MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation�&Hng Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity -OTTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> Ilons Bagsgoa Ilons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest Bags BentonitefCement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 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 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 1 25 50 5 <br /> 15 30 6 1 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 4 80 8 <br /> 12 �5�� �"LI�9 a 10/16/2017 <br /> 1888 E. HazeltonAyenue E Stockton, California 95205 1 T 209468-34201 F 209464-0138 I www.sicehd.com <br />