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SKJOAQUIN <br /> , —COUNTY— <br /> �:n�,ironmenW Health Department. <br /> • r..a'I"_''' ',' <br /> Greatness growshere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 61 1(o 1202u Inspector: Y, Sae+2 r n CONSTRUCTION <br /> Facility Address: hf. FUffe ST. <br /> Well Address: Total Depth: <br /> WP#Q44c�4yl0 Well#: Drilling Rig Type: Grp <br /> Soil Boring#: ea , Gb\ Min 2"Annular EHD Seal VeNfied: ❑Yes ❑No <br /> Drilling Company: Vjd W i� 'tlibg <br /> Driller Onsite: Ansel Franl- Screen Length From: To: <br /> �— <br /> Consultant: Filter Pack From: To: <br /> _ale°n-(elder <br /> Geologist: -Ac-nPr 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 <br /> atsov�-�t��rtr3 c;--rRtsrt'-$ox " <br /> Holding Temperature: COWLEM N t o <br /> Method: [�rmirxtsrut�ca- , <br /> Screening Method: eros <br /> Verified Chain of Custody: ❑ Yes ❑Nott- <br /> tt. <br /> SPOILS " _ <br /> Contamination Noted: ❑ Yes []No <br /> x C. <br /> If yes,spoils storage Location: slotma r <br /> stun �, — <br /> Covered: 11 Yes ❑No = 9—W;ac�- <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water:_ _ (o f4 (Y93 20i ft <br /> Grout Material: gee Ce(nOcN <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:_ 10a.8a gallons <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation$Boring 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 /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 941b <br /> gallons Bags gallons BaRs <br /> Thickest Thinnest ilBags Thickest Thinnest 4Bags BentonitelI ement Mix 3% Mix 5% Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.4d7_ <br /> s 10 2 10 20 2 Bentonite per 941b 2.82 4. <br /> 7.5 15 3 15 30 a <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 a 40 80 8 <br /> I� bags 10/15/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />