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SAN 10AQUIN Environmental Health Department <br /> —COUNTY— y' <br /> ur.=rt r,�;.5 yrn res here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> z� �g � <br /> Date: � Insp tor: CONSTRUCTION fit 'r <br /> Facility Address: � vVYI ayv��,C v i ^ <br /> Well Address: Total Depth: 2� J Ill % ,y <br /> WP# �J 0 Well#: Drilling Rig Type: S <br /> Soil Boring#: I b^ <br /> Drilling Company: In 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: A- Filter Pack From: To: <br /> ►� Bentonite From: To: <br /> Geologist: t <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No On <br /> casing S If yes,yes,location and distance: 37 height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: co&FLErJON co�oN G <br /> Method: Ground Suia" <br /> Screening Method: grout S ,D <br /> Verified Chain of Custody: ❑ Yes El No �tt• C <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: abned <br /> section <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ' <br /> Depth to Water Q <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: -�v ,. <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction �� Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation^oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> []PressureGrout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest IBags 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 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 1 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 10 1 40 8 40 8o 8 <br /> 150 +C <br /> S 10/16/2017 <br /> 1868 E. i�a'zelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />