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SAN IDAQUIN Environmental Health Department <br /> .C.O U N T Y= <br /> Greatness grows here- <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: tCYX) CONSTRUCTION <br /> Facility Address: 4-�w� A- (IVF. <br /> Well Address: Total Depth: <br /> WP# `1 Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: �M,V Screen Length From: To: <br /> Consultant: „{� p �C _fj�� h Filter Pack From: To: <br /> Geologist: r�AA �1 <br /> �'–' �� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes $No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes V3,N0 cas;na <br /> If yes, location and distance: height <br /> SAMPLING -r;a�ct�Nn <br /> Holding Temperature: CO&FLEETION c +c 4P�LEncN <br /> Method: c�rocind scrracs ,�► <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes ❑No ' <br /> it. <br /> SPOILS J <br /> z- <br /> A _• O <br /> Contamination Noted: ❑ Yes to P = a <br /> If yes,spoils storage Location: stanad - <br /> Covered: ❑ Yes El No <br /> — ,mt Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 2S tL�' . <br /> Depth to Water: <br /> Grout Material: C�s.Arr.A1 <br /> Used: (�rj�- ,��, MATERIALS/DEVELOPMENT <br /> Gallons of Grout Us <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation Noring 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 INTremie ❑Other: Type of Method: <br /> Water I Cement 471b Water Cement 941b <br /> lions Bas Rallons Ba s <br /> Thickest Thinnest Bags Thickest Thinnest #Bags SentoniteXement Mix 3% MIX 5% Mix <br /> 2.3 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 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 D 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />