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N I J OAQUIN Environmental Health Department <br /> << P' Greatness grows here. <br /> Gj Monitoring Well/Soil Boring Inspection Report <br /> Date: J I 1 Inspector. � �� ��?�' � CONSTRUCTION <br /> Facility Address: <br /> WellA/dd ess: Total Depth: II 1 <br /> WP# C/ Well#: Drilling Rig Type:—(, I UAVI� l� S <br /> Soil Boring#: l , Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: VI WDir11"Y11 <br /> Driller Onsite: v-ci'k Screen Length From: To: <br /> Consultant: 1 Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLS ION �1FnoN <br /> Method: Ground Surf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —`----n' <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: El Yes El No <br /> _ <br /> If yes, spoils storage Location: stotWd E <br /> sn — 3 <br /> Covered: ❑ Yes ❑No =' - <br /> 9ravol pack <br /> If yes, material: <br /> GROUTING or DESTRUCTIONotal Depth: ��/ X2) A FE <br /> Depth to Water: ✓0 A ,— it. n' <br /> Grout Material: MedA cynep-t 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 Boring Destruction <br /> Bags of 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 Cemen 471b Water Cement 941b <br /> allons Ba allons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest uBags 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 /> 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 1 40 80 8 <br /> S 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />