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S A N A 0 A 0 U I N <br /> Environmental Health Department <br /> = <br /> COUNTY <br /> Greatness <br /> OUNTYGreatness grows here. <br /> q Monitoring Well/Soil Boring Inspection Report <br /> Date: D Z ICI Inspector: S LAKh-cct CONSTRUCTION If <br /> Facility Address: lII l W (cn-kLLnA 13 wet 6 d G1wt4-r <br /> Well Address: Total Depth: <br /> WP# ,�{U Well#: Drilling Rig Type: <br /> Soil Boring#: R1 — R6 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: IG C r-GLC— <br /> DrillerOnsite: chvlS Screen Length From: To: <br /> Consultant: —�L1'Y7AGi) V 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 A WVE-GROUND <br /> Holding Temperature: CONFLEUDN COMPLEnON <br /> Method: Gmund Suriacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> tt. <br /> SPOILS . <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stonad _ - Z <br /> aac5on = <br /> Covered: ❑ Yes ❑No gr,,,W <br /> Pack <br /> If yes, material: l x <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tt• tt' <br /> Grout Material: NpAt (yu" <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Nboring Destruction Slot Size: <br /> Bags of 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 /> allons Bas gall ons Bags <br /> Thickest Thinnest gs Thickest Thinnest 9Bags 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 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 3 <br /> MS W J t�'- n ANW l 0- l�llDl 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 9x52-05 1 T 209 4V68-3420 1 F 209 464-0138 1 www.sicehd.com <br />