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• . ' • SAN JOAO iIN 'i:m t t <br /> --COUNTY— <br /> N/ionitoring Wek/Soil Bolling Inspection Report- <br /> Date: oZl�� InspectoCONSTRUCTION <br /> Facility Address: _q 3 37 MOS+ gW m ejj&4 <br /> Well Address: Total Depth: <br /> WP# `L Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: M zaar) vcr 2 r 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: <br /> SAMPLINGovE oaour D <br /> Holding Temperature: cOh�i LET;014 cor,�F1�-I,orxi <br /> Method: m .G`x'r'd Sutacs <br /> Screening Method: pr��s_�� <br /> Verified Chain of Custody: ❑ Yes ❑No –'' <br /> _ft. <br /> SPOILS —_ <br /> _ C <br /> Contamination Noted: ❑ Yes El No _ <br /> If yes,spoils storage Location: <br /> clat2ad — o <br /> Covered: ❑ Yes []No = ; <br /> If yes, material: <br /> GROUTING or DESTRUCTION Tot Depth: <br /> Depth to Water: — n <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> Slot Siz <br /> ❑Boring Installation &&ring Destruction Bags iz 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 Cement 4711) Water Cement 941b <br /> allons Bags Rallons Baas <br /> Thickest Thinnest «Bags Thickest Thinnest ^Bags Bentonite/Gement 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 so 5 <br /> 130 30 e <br /> 17.. 7 705 35 7 35 70 (✓'t �� /J �` %/�� <br /> 20 40 s au eo <br /> f• / L�13 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 I T 209 468-3420 F 209 464-0138 I www.sicehd.com <br />