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SAKJOAQUIN <br /> Environmental Health Department <br /> COUNTY— <br /> ���� * G•eotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: a l to Inspector: CONSTRUCTION <br /> CONSTRUCTION <br /> Facility Address: <br /> Well Address: �k1a43 Total Depth: 10- is Ff (� <br /> WP# 'J`\al\\ _ Well#: \— l0 Drilling Rig Type: __w rta`1b�- <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company:��- SVS_ �Cf t,,�Qpu�Q <br /> Driller Onsite: FA_Js/`J-� Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes %,No casing <br /> If yes, location and distance: height <br /> —q, <br /> SAMPLING ABOVE-GRCU co <br /> YPLETlor� ctials�-sox <br /> Holding Temperature: cc+,wt.FneN <br /> Method: <br /> Ground Swfx+ <br /> Screening Method: c►cut <br /> Verified Chain of Custody: ❑ Yes ❑No ' <br /> ;t. I <br /> n. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes []No <br /> If yes,spoils storage Location: slo <br /> ned <br /> aKien �1 _ <br /> Covered: ❑ Yes ❑No = <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: =_ <br /> Depth to Water: ____ <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT ,,\\ <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> []Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Ba s <br /> Thickest Thinnest Bags Thickest Thinnest "Bags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 2.5 5 1 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 1G 2e 2 Bentonite per 94 Ib 2.62 4.7 <br /> 7.5 35 ? 15 30 3 <br /> 30 20 < 20 40 4 <br /> 12.5 25 5 25 s0 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 70 7 <br /> 20 40 E EO 9 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue( Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />