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SAc AN n I I <br /> .P10AQUIN <br /> 1< WZ�0. —COUNTY— Environmental Health Department <br /> Greatness grows here. <br /> 0� �} Monitoring Well/Soil Boring Inspection Report <br /> Date:O `I "1 Inspector: <br /> Facility Address: <br /> Well Address: _Oon . tU`S��-Iwy_ � . Total Depth: <br /> WP# 3Aa\r-,''k, Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: , WikAO— S <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: El Yes Ly1No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: St Yes /❑No <br /> k casing <br /> If yes, location and distance: 3� e�1,U.L �C. _6� height <br /> SAMPLING AIBCVE-GROUND <br /> Holding Temperature: iCOWLETION �LErioN <br /> Method: G«ndSurta" + ....- <br /> Screening Method: crcxA <br /> 1 <br /> Verified Chain of Custody: ❑ Yes El No S n <br /> it. <br /> tt. <br /> SPOILS <br /> 0 <br /> Contamination Noted: ❑ Yes []No <br /> If yes, spoils storage Location: atcnod <br /> ssc4on x — .8 <br /> Covered: ❑ Yes ❑No <br /> _ grayst pads <br /> If yes, material: <br /> GROUTING or DEST�CT��Total Depth:_ - <br /> Depth to Water: tL 2 r n <br /> Grout Material: Q� ��ti�-C� �,�Y��,,QS <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: r FiL <br /> ❑Well Installation Vell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑BSlot Size: <br /> oring Destruction Bags Size: <br /> 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: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gall ons Bags <br /> Thickest Thinnest pBags Thickest Thinnest #Bags Bentonite/Gement 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 30 6 30 60 6 <br /> 17.5 35 7 35 7D 7 <br /> 20 40 8 4D 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />