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SAN 10AQ U I N Environmental Health Department <br /> "I'.�. `j COUNTY <br /> �cqr„i Greatness grows here. <br /> II�� Monitoring Well/Soil Boring Inspection Report <br /> Date: V U Iq Inspector: ����1�17 CONSTRUCTION <br /> Facility Address:� � <br /> Well Address: Total Depth: <br /> WP# 00kG (�61 Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2”Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 6 r 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 ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVg.Ggp()ND <br /> Holding Temperature: COWLETION ciEnoN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> ft. <br /> SPOILS :x <br /> v _ e <br /> Contamination Noted: ❑ Yes ❑No <br /> C <br /> If yes, spoils storage Location: ebtted <br /> .ec9on <br /> Covered: ❑ Yes ❑Nci gr,,,sl pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: Z-30 2-2011 I -IU, x <br /> Depth to Water: n• tt' <br /> Grout Material: Ntix� (_�Nt>A; MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑ T 1 <br /> Boring Installation Boring Destruction Bags iz 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 me 471b I Water Cement 94 lb <br /> allons Bas galll ons Bags <br /> Thickest Thinnest ags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.821 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 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />