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SANz,,JGAQUIN Environmental Health Department <br /> !-°'I'_" `,' — <br /> COUNTY <br /> — <br /> c�u�ca� Greatness grows fere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 101aclAq Inspector: Y)yfsfina CONSTRUCTION <br /> Facility Address:itfl000 YV.5clntik+e pA <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: HSR <br /> Soil Boring#:�,���zo, ►q, 23, 1X Min 2"Annular EHD Seal Verified: 1-1Yes ❑No <br /> Drilling Company: Vo W <br /> Driller Onsite: F,c'ot�n1� Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist:_ 'bctn 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: height <br /> SAMPLING 118QVS-l§ROUND cmR. . <br /> Holding Temperature: COWLETION COMP�LfiMN <br /> Method: SLrrxs + <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑Noft• <br /> S. <br /> SPOILS ft <br /> a— <br /> Contamination Noted: 171Yes ❑No <br /> aF <br /> If yes,spoils storage Location: aloud <br /> :.. <br /> sas5on "' a <br /> Covered: El Yes ❑No <br /> _. 9-11Wpa�c <br /> If yes,material: ` <br /> GROUTING or DESTRUCTION Total Depth: 416.2(.5' x <br /> Depth to Water: gore f fL <br /> Grout Material: t.,ea\- CPrnPjnt- Alw 261 <br /> Gallons of Grout Used: =o Qc,1 <br /> +t vv.11.5' MATERIALS/DEVELOPMENT <br /> �lw).6 V Casing Type: <br /> ❑Well Installation ❑Well Destruction , Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation I013oring Destruction 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 47 lb Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags BenWnitefCement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 16 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 1160 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> lf-El�S.\ 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />