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i SAN 10AQUIN <br /> Environmental Health Department <br /> I•-� —COUNTY-- <br /> ° P Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 Inspector: ' Q�� CONSTRUCTION <br /> Facility Address: oe <br /> Well Address: Total Depth: l J 6::�!— <br /> U�WP# DJ S 02 Well#: Drilling Rig Type: 'aJ `oV <br /> Soil Boring#: 2 <br /> Drilling Company: ­Tok-10 ;j1 Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Driller Onsite: o Screen Length From: To: <br /> Consultant: DC urn Filter Pack From: To: <br /> Geologist: AM Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GRCUNo <br /> Holding Temperature: CONFLETION noN <br /> Method: Ground Surface <br /> Screening Method: or� <br /> Verified Chain of Custody: ❑ Yes El No n' <br /> tt. <br /> ft. <br /> SPOILS <br /> r = o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: abttad = o <br /> a�c'Jon .�; <br /> = B <br /> Covered: ❑ Yes ❑No _ 9-911 P&* <br /> If yes, material: =_ <br /> I � — <br /> GROUTING or DESTRUCTION Total Depth: 21 <br /> Depth to Water: s n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 3oZ UJ' <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Boring 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 IQQ Tremie ❑Other: Type of Method: <br /> Water Ceme t 47 lb Water Cement 941b <br /> allons Bag gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5% Mix <br /> 2.5 s 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 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 40 80 8 <br /> V )d --7-' 6Y f 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />