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SAN 10AQUIN <br /> Environmental Health Department <br /> �Q <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 Inspector: / CONSTRUCTION <br /> Facility Ad ress: V <br /> Well Address: j Total Depth: <br /> WP# 301Well#: Drilling Rig Type: T 1� (p <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: hl � .� Screen Length From: To: <br /> Driller Onsite: jD <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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-GROUND <br /> Holding Temperature: coE ION � <br /> n'�� iFnON <br /> Method: GmndSulacs T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —n' <br /> it. <br /> tt. <br /> SPOILS H; <br /> ' a <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes,spoils storage Location: .totted <br /> socion <br /> Covered: ❑ Yes ❑No <br /> gravel Pack <br /> If yes, material: <br /> GROUTING or DESTR CTION Total Depth: h <br /> Depth to Water: tt tt' <br /> Grout Material: NeAt cwwby MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation Loring Destruction Bags of Cement: <br /> METHOD USED l Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity UTremie ❑Other: Type of Method: <br /> Water ent 471b Water Cement 941b <br /> allons L Ba eallill ons Bags <br /> Thickest Thinnest It Bags Thickest Thinnest ttBags 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 1 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 354 t -I bals 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />