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S Q N J O QQ U I N Environmental Health Department <br /> —COU NTY— <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: qhV120g Inspector: , 0n,fq CONSTRUCTION <br /> Facility Address: �6(, �( b P,1it, <br /> Well Address: pIn Total Depth: <br /> WP# Well#:_Mwal Drilling Rig Type: <br /> Soil Boring#: <br /> � j� Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: d `�lV! b <br /> Driller Onsite: �� Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: �S <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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CO 'LE1ON CCCWLE,nCN <br /> Method: G=nd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft' <br /> tt. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: El Yes ❑No r` _ <br /> If yes, spoils storage Location: clod <br /> sac�on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: max. <br /> �l t y' <br /> GROUTING or DESTRUCTION Total Depth: —1Z.5 <br /> Ir <br /> Depth to Water: ^� If , n• n' <br /> Grout Material: N 1' > 1'11�n►� <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> It Type/Brand of Bentonite: <br /> El Pressure Grout Over Drill `� Filter Pack Type/Size: <br /> ❑ Gravity /'Zremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />