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SANAOAQUIN <br /> Environmental Health Departrnent <br /> '�^tU;-c�^'• Greatness grr�r,s r}zr'F. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: Y)0 Sayei 11 CONSTRUCTION <br /> Facility Address: P)ff, % lc a" M <br /> Well Address: Total Depth: <br /> WP#-Qty{'o24tr Well#: Drilling Rig Type: 14.E' (X <br /> Soil Boring#:_Q� 16-wP_ ?AV-1 � 3 <br /> Drilling Company:Kra2fw F� A��fifes <br /> Min 2"Annular EHD Seal Ve'Mfied: El Yes El No <br /> Driller Onsite: C�l\O%s Screen Length From: To: <br /> Consultant:K�nzw �, Am s enc. Filter Pack From: To: <br /> Geologist: waune 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 /> cas3.ng <br /> If yes, location and distance: height <br /> SAMPLING - ABOVE-bROUND tsrY sox <br /> Holding Temperature: cowi ErioN <br /> Method: c�csind sxs <br /> Screening Method: $� <br /> Verified Chain of Custody: ❑ Yes ❑Noft- <br /> Y_ <br /> SPOILS " <br /> Contamination Noted: ❑Yes ❑No }� <br /> If yes,spoils storage Location: <br /> Covered: ❑ Yes ❑No <br /> If yes,material: m <br /> GROUTING or DESTRUCTION Total Depth: A 10' <br /> Depth to Water:,. 5 Et B qac <br /> Grout Material: NeCft MATERIALSIDEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation VBoring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> 1 Gravity Vemie V ❑Other: Type of Method: <br /> Water cement 47 lb Water Cement 941b <br /> allons Bags lions 08 <br /> Thickest Thinnest ti Bags Thickest Thinnest 4Bags BentoniteXement Mix 3%IVI'X 5°1° tl�lix <br /> 2.5 5 1 5 10 1 Dentonife per 47 Ib 9.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 941b 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 S <br /> 15 30 6 30 60 5 <br /> 17.5 35 7 35 70 7 <br /> 20 40 a 40 80 8 <br /> lb boys - 10/16/2017 <br /> 1868 E.Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 1 www.sicehd.com <br />