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SAN. 1UAQUIN Environmental Health Departmrsen' <br /> COUNTY— <br /> Gi--atness gror,s h,„re. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: - 7 p D 119 Inspector: VOW;a A- CONSTRUCTION <br /> Facility Address:/14OuA' #' N <br /> Well Address: Total Depth: <br /> WP# 60'5991Well#: Drilling Rig Type: <br /> Soil Boring#: 1 ' Min 2” Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: V I IN I in <br /> Driller Onsite: ✓! Screen Length From: To: <br /> Consultant: l4 -e- 1961— Filter Pack From: To: <br /> Geologist: L 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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND CILM__ <br /> Holding Temperature: COMPLETION COMPLEMN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes 1:1 No �tt' <br /> t:. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: n I; 20� slotted <br /> .on B <br /> Covered: El Yes ❑No g-vw P--k <br /> If yes, material: g3;?b <br /> GROUTING or DESTRUCTION Total Depth: QQ8``� 301 _= <br /> Depth to Water: D� 5 I tt. tt. <br /> Grout Material: to <br /> Gallons of Grout Used: t0 Oj —6j.-,51 MATERIALS/DEVELOPMENT <br /> Q 1 Casing Type: <br /> ❑Well Installation ❑Well Destruction 89' I0 Blank Feet Screen Feet <br /> ❑Boring Installation XBoring 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 ❑Tremie ❑Other: <br /> Type of Method: <br /> Water Cement 7lb Water Cement 941b <br /> allons Bas eall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags 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 1 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 1 8 40 80 8 <br /> 1,105 904 315 10aO 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />