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SANAOAQUIN <br /> Environnie nal Health Department <br /> —COUNTY— <br /> Greatness <br /> COUNTY— <br /> Greatness grows here. <br /> J Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: K SCle+Qrr% CONSTRUCTION <br /> FacilityAddress:24&0 S. Nctmrkhur Dlr <br /> Well Address: Total Depth: <br /> WP#00402G4 Well#: Drilling Rig Type: <br /> Soil Boring#: oil/p85 A �A � �Q t Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: rceaa <br /> Driller Onsite: - rmo�,n Wc��e Screen Length From: To: <br /> Consultant:Non_cd&,W- 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 <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING <br /> ABOVE-bROUND <br /> Holding Temperature: cowLErjo a $° <br /> cETTON <br /> Method: GmtI dSmUcs <br /> Screening Method: trout <br /> Verified Chain of Custody: ❑Yes ❑No <br /> ft. <br /> SPOILS ` <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> tion •'= � <br /> Covered: ❑ Yes ❑No Y _` <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: q2 Ft (D50, <br /> Depth to Water: <br /> Grout Material:Nea cern MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 1� 4 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> El Boring Installation,Boring Destruction Bags Slot Siziz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity YTremie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 941b <br /> allons Bags gallons sags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%mix :5% Mix <br /> 2s s 1 s 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 18 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 1s 3 15 30 3 f <br /> 10 20 4 20 40 4 <br /> 125 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 3 70 7 <br /> 20 40 8 40 80 8 <br /> 2'�2 Sys 10/16/2017 <br /> 1868 E. Hazelton Avenue } Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />