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SAN 10AQUIN Environmental Health Department <br /> —COUNTY <br /> Greatness grows her.- <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ZI 1 Inspector: S44'rt + CONSTRUCTION <br /> Facility Address: Z <br /> Well Address: Total Depth: <br /> WP# L C) Well#: Drilling Rig Type: <br /> Soil Boring#: (- P T I Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite: fvo) I C Screen Length From: To: <br /> Consultant: yv <br /> t' Filter Pack From: To: <br /> Geologist: I v" et/V\- 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: WT <br /> height <br /> SAMPLING ABOVE-GACUND <br /> Holding Temperature: COWPLETION CC.1PL.ETICN <br /> Method: Ground Sumac' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No n. <br /> ft. <br /> h. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: .icnad <br /> aon _ <br /> Covered: ❑ Yes ❑Nopacx <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water 5ft; <br /> Grout Material: Nea (C , <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring InstallationlBoring Destruction Bags of Cement: <br /> METHOD USED I Bags Sand/Gravel: <br /> El Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity "1Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bag's izallons Bags <br /> Thickest Thinnest PBags Thickest Thinnest VBags Bentonite/Gement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 `� 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 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 www.sicehd.com <br />