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SAN._-J0AQU1N Environmental Health Department <br /> —.C.O U N T Y— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:�'N o �Py�Inspector: CONSTRUCTION <br /> Facility Address: ,, � <br /> Well Address: �" Q�fii�^�VRQ A0�"ual Depth: <br /> WP# ��r��°� Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: M�Q,4\w Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Driller Onsite: � •5• '� ��� Screen Length From: To: <br /> Consultant: !tel � d P<N� _ Filter Pack From: To: <br /> Geologist: �\9..1.�r\,� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: �kYes ❑No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes kNo casing <br /> If yes, location and distance: might <br /> SAMPLINGABOVE-GROUND <br /> Holding Temperature: cot, LETioN c sFtErtort <br /> Method: G=nd Swa= <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> -ft. _ <br /> SPOILS J <br /> Contamination Noted: ❑ Yeslo ` = o <br /> If yes,spoils storage Location: <br /> axcaon '— <br /> Covered: ❑ Yes ❑No <br /> _ ,' gzvat pans <br /> If yes, material: <br /> GROUTING or DESTRUCTION Tot I Depth: <br /> Depth to Water: �� " 1% �g�_ IF <br /> ' ! ' <br /> Grout Material: '_A C__'t; S MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: "�k &a o% <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity 1�k\Tremie ❑Other: Type of Method: <br /> Water + Cement 471b Water Cement 94 lb <br /> Ilons I Bas allons Bags <br /> Thickest Thinnest (Bags Thickest Thinnest #Bags Bentonite/Gement Mix 3% Mix 3% 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 20 40 <br /> 12,5 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 80 6 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 E 209 464-0138 1 www.sicehd.com <br />