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� � SAN_,J0A0UIN <br /> CoA <br /> COUNTY- <br /> Environmental Health Department <br /> f <br /> , Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 (I liq Inspector: , 4CONSTRUCTION <br /> Facility Address: S. <br /> Well Address: Total Depth: <br /> WP# Dn 'li3 Well#: ^p Drilling Rig Type: <br /> Soil Boring#: CST —( p —to q CeT /0 4/(A"06Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant:��i r �t°iY Filter Pack From: To: <br /> Geologist: / l/✓ 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 casing <br /> If yes, location and distance: height <br /> _W1 9 <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLEr1ON COMPLETION <br /> Method: G=nd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No It, —ft. <br /> ft. <br /> ft. <br /> SPOILS = <br /> = o <br /> Contamination Noted: ❑ Yes El No = <br /> If yes, spoils storage Location: <br /> slotted = 8c(y')0 on <br /> Covered: ❑ Yes []No <br /> AJ ' <br /> If yes, material: C� OA . 3' <br /> GROUTING or DESTRUCTION Total Depth: CST 10 C• g� <br /> Depth to Water: 7 n• tt' <br /> Grout Material:A/&f LQ/Y/t.141 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Q o., _ <br /> Casing Type: <br /> ❑Well Installation []Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation El Boring 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 54Tremie ❑Other: Type of Method: <br /> Water Cement 71b Water Cement 941b <br /> allons Bas allons Bags <br /> Thickest Thinnest uBags Thickest Thinnest 9Bags 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 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 8 40 80 8 <br /> (j Q Oul J.'s b�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 />