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CA. SAN 10AQUIN Environmental Health Department <br /> COUNTY <br /> Y' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:�7 Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: �jS <br /> d (� <br /> WP# s Well#: Drilling Rig Type: SI <br /> Soil Boring#: — � ! �6! <br /> Drilling Company: Min 2" Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: ; `�S IFeen Length From: To: <br /> Consultant: Al, ter Pack From: To: <br /> Geologist: yv, ,e- 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 casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GRCXJND <br /> Holding Temperature: COMPLETION COPLEnoN <br /> M <br /> Method: Ground SLOwe <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt. <br /> tt. <br /> SPOILS tt. <br /> Contamination Noted: ❑ Yes ❑No r <br /> If yes, spoils storage Location: ( slotted ! <br /> l0 ..�n _ <br /> Covered: ❑ Yes ❑No <br /> g.,:W pads <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> t tt, = tt. <br /> Depth to Water: Q <br /> Grout Material: D <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation LBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cemen 471 Water Cement 94 lb <br /> allons Bas 2allons Bags <br /> Thickest Thinnest 1t Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 1 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 /> C / !, pI 1 b"S 10/16/2017 <br /> 1868 E. Hazelton Aven`u`e I S4ckton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />