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c <br /> SANsJOAHINEnvironmental Health Department <br /> —COUNTY— <br /> FO <br /> FO Greatness grows here. <br /> Q ��jj�� Monitoring Well/Soil Boring Inspection Report <br /> Date: 'N/Z0W lnnjs ector: I r0— CONSTRUCTION <br /> Facility Address: �j 9� OS r <br /> Well Address: Total Depth: I <br /> WP#00 q 0 4,6 X Well#: Drilling Rig Type: <br /> � HSAV <br /> Soil Boring#: 10 — aZ- Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: �o S- E ore, ot1 <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Ar S $ Yom$ ,- C Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No caning <br /> If yes, location and distance: fl height <br /> Fj <br /> SAMPLING Aeove.GAouNo <br /> Holding Temperature: OOWLErlON =AAPR- ON <br /> Met hod: r 1 Ground Suiact <br /> Screening Method: 010 <br /> Verified Chain of Custody: El Yes El No <br /> $I' 2 tt. <br /> 812: i4 tt, _ <br /> SPOILS <br /> k ' <br /> Contamination Noted: ❑ Yes []No 1&1 . Iq <br /> If yes,spoils storage Location: 615'. Igt sbitad <br /> too <br /> ..ten <br /> Covered: El Yes El No ��6' = <br /> If yes, material: ( 19vell <br /> park <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Wateryl 0 yl 11Z, <br /> Grout Material: 5� <br /> Gallons of Grout Used: 5 �2� 5 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> []Boring Installation*oring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement Ib Water Ceme 416 <br /> allons Bas igallons Ba <br /> Thickest Thinnest #Bags Thickest Thinnest »Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 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 20 420 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 6 40 80 8 <br /> (, bap 2 ba Q S 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />