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SAN J0A0UIN <br /> (.;,, ,. „ :_ Environmental Health Department <br /> --COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2020 Inspector:' 0`r- CONSTRUCTION p /� <br /> Facility Address: �r Pr✓ca ��. �j S 4 6?J< i�St4 <br /> Well Address: Total Depth: <br /> WP# 0 5 Well#: Drilling Rig Type: 7� 01 <br /> Soil Boring#:��, P Zo,IBZZ, 8�? 2S 3 I Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: o og <br /> 1 Screen Length From: To: <br /> Driller Onsite: r I 1 Filter Pack From: To: <br /> Consultant: 't-e r-4L-co ki <br /> Geologist: yLA C,pu/Yl 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 using <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND C __ <br /> Holding Temperature: COMPLEr10N COMPLEncN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No -»' <br /> ft. <br /> SPOILS y� r—� - <br /> � _ <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: t�27i• S I slotted ._ <br /> �Z $ ..cion _ <br /> Covered: ❑ Yes ❑Non _ I O I _ g.,W� <br /> If yes, material: ��11 "l I <br /> GROUTING or DESTRUCTION Total Depth: Sv ?'"7 J�`• <br /> Depth to Water: — g n' <br /> Grout Material: CLZnZ4d MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation•CBoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> 31 Filter Pack Type/Size: <br /> Od Gravity VTremies� 8❑Other: Type of Method: <br /> Water Cemen LI Water Cement 94 lb <br /> gall s Bas gallons Ba s <br /> Thickest Thinnest tlBags Thickest Thinnest It 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 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 1 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209468-34201 F 209464-0138 www.sicehd.com <br />