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SAS .J0AQU1 Environmental Health Department <br /> .C.O U N T Y= <br /> Greatness grows here_ <br /> f <br /> Monitoring Quell/Soil Boring Inspection Report <br /> Date: � Z`Ii 7X inspector: I&O J�- CONSTRUCTION <br /> Facility Address: iWlff <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: / _ S' <br /> Min 2"Annular EHD Seal Verified: 11 Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: p►.�y0 �y)�y�yt �/�;, Filter Pack From: To: <br /> Geologist: ,9� fj t-"-7/4 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes Ila COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ YesNo casing <br /> If yes, location and distance: might <br /> 7 <br /> SAMPLING A VE-GRCUND <br /> r srrfox <br /> Holding Temperature: Cowt�'T0N cc�sFt.;:Tror; <br /> Method: CDC ` + <br /> Screening Method: a� <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> it. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes Clo = a <br /> If yes,spoils storage Location: stet y- <br /> saC10n — <br /> Covered: ❑ Yes ❑No _ <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ( - <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: `7 S Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation)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 gTremie ❑Other: Type of Method: <br /> Water I Cement 471b Water Cement 94 lb <br /> allons { Baas allons Bags <br /> Thickest Thinnest Bags Thickest Thinnest #Bags Bentonite/Gement Mix 3% MiX 5% Mixt <br /> 2.5 s 1 s 10 1 Bentonite per 47 Ib 1.411 2.4d7_ <br /> 5 �o z 10 20 2 Bentonite per 94 Ib 2.82 4. <br /> 7.5 1s 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 I 7 3s 70 7 <br /> 20 40 8 40 8= 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 />