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SAN-JIDAQUIN Environmental Health Department <br /> .C.O U N T Y-- <br /> Gr-entness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 0,))1?/t1,07,0 Inspector: htm v_ CONSTRUCTION <br /> Facility Address: U.6f' "w) <br /> Well Address: Total Depth: <br /> WP# C)0 A b S'6 k Well#: Drilling Rig Type: <br /> Soil Boring#: IS - 1 7 11) <br /> Drilling Company: tf44_ trlN Min 2"Annular EHD Seal Verified: ❑ Yes E]No <br /> Driller Onsite: Q.o6- QJ� } _ Screen Length From: To: <br /> Consultant: �V'ki -o' A.�%�0680f) Filter Pack From: To: <br /> Geologist: AIS iv A- tp�C_ Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 1I No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yeslo casing <br /> If yes, location and distance: height <br /> SAMPLING tf_cp <br /> Holding Temperature: cokFU= on CC+AFLETi0Ni <br /> Method: a`°""as`�r <br /> Screening Method: arOA <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> if. <br /> SPOILS <br /> oil <br /> Contamination Noted: ❑ Yes ❑No —' a <br /> If yes,spoils storage Location: siatutd �_ a <br /> saaion — -a <br /> Covered: ❑ Yes []No <br /> jR EE ', sPaCk <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_ =_ <br /> Depth to Water: All A - ' <br /> Grout Material: AJfA-f L&JO/LNi_ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: U �o.� 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 NTremie ❑Other: Type of Method: <br /> Water I Cement 471b Water Cement 941b <br /> allons Bags allons Ba s <br /> Thickest Thinnest #Bags Thickest Thinnest #Sags 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 /> L17.5 35 1 7 35 70 7 <br /> -20 40 80 B <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sicehd.com <br />