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SANJOAQUIN Environmental Health t-eparti eat <br /> —.C.O U N T Y— <br /> Greatness groins here. <br /> Monitoring Quell/Soil Boring Inspection Report <br /> 1 1 <br /> Date: �J,OZ 20w Inspector: CONSTRUCTION <br /> Facility Address: USI D) (_iA� OAA-, <br /> Well Address: Total Depth: <br /> WP# 40bZj, Well#: Drilling Rig Type: <br /> Soil Boring#: %'t <br /> Drilling Company: '(�C��,�CAS Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Screen Length From: To: <br /> Driller Onsite: kwAl� <br /> Consultant: ti�%L b ��i oN Filter Pack From: To: <br /> Geologist: A41\1 � 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 - . �asu,g <br /> If yes, location and distance: heght <br /> SAMPLING ABOVE-GROUND <br /> c0rVi�not� c sox <br /> Holding Temperature: cct !_En'CN <br /> Method: GrmndSurrxa T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ' <br /> tt. _ <br /> SPOILS <br /> Contamination Noted: -1 Yes []No <br /> If yes,spoils storage Location: ssanad _ - <br /> stc�on <br /> Covered: ❑ Yes ❑No M <br /> ,f•nvat pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:5TJ <br /> Depth to Water: 'lam �gL - fL <br /> Grout Material: 001i IYSN <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installationoring 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 �(Zremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> gallons Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest riBags Bentonite/Gement Mix 3% MIX 5% MIX <br /> 2.s 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 —i <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 80 8 <br /> 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 />