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P i�N <br /> SAN 10 A Q U I N <br /> _ Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> /,� Monitoring Well/Soil Boring Inspection Report <br /> Date: 2- � I Inspector: CONSTRUCTION <br /> Facility Address: J <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> °(A <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: I�-% 'y- 1-6 l� <br /> Driller Onsite: V1 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 ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-G RCUNp CHRISW_ <br /> Holding Temperature: COMPLETION CQWLETION <br /> Method: Ground Sudwe <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes El No —ft. <br /> ft. <br /> fi. <br /> SPOILS <br /> 0 <br /> Contamination Noted: El Yes El No <br /> If yes, spoils storage Location: abt�d <br /> wagon <br /> Covered: ❑ Yes ❑No <br /> g-vlw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ft. — ft. <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 InstallationlBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> E] Gravity �Tremie []Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall s Bas Rallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest pBags 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 /> 25 5 25 50 5 <br /> is n Q I <br /> 15 L 30 30 60 6 L (N�� <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />