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j_QUiN S A N X10 AQ U I N <br /> Environmental Health Department <br /> " 0 �' —COUNTY— <br /> Greatness grows fere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1't, Inspector: CONSTRUCTION <br /> Facility Address: 13 b"XA\_k'. <br /> Well Address: Total Depth: <br /> WP# C)n A'ln S\p Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <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: ❑ 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 /> EHolding Temperature: COMPLEVON OP lN <br /> Method: G=nd 5urlace ' + <br /> Screening Method: grout <br /> i <br /> Verified Chain of Custody: El Yes El No <br /> * �t. <br /> SPOILS <br /> n <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes, spoils storage Location: atoned <br /> ssoson <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:5� �'�• <br /> Depth to Water: ?, �k, `" <br /> Grout Material: � CC»rc�_ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <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 /> ❑Pressure Grout ❑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 /> wall s Bas gallons Bags <br /> Thickest Thinnest it Bags Thickest Thinnest it 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 /> s 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 so 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 Bo 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 />