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UIN=c�� S A N.P10AQ U I N <br /> Environmental Health Department <br /> COUNTY----- <br /> �e�7*0 Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ZV Inspector: SU CONSTRUCTION <br /> Facility Address: (1 <br /> Well Address: Total Depth: �1 M.(�lL� /�474- <br /> WP# C:tt cg6f C5Well#: Drilling Rig Type: I <br /> Soil Boring#: CC Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite: nye. Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: 'tly <br /> 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-GROUND <br /> Holding Temperature: COWPLE ION COMP�L.EMN <br /> Method: G=nd Surfact <br /> Screening Method: ar«A <br /> Verified Chain of Custody: ❑ Yes El No �tt' <br /> tt. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: abttod _ B <br /> satyon �; — <br /> Covered: El Yes ❑No _ g-;w Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: D __ <br /> Depth to Water: �— n• n' <br /> Grout Material WLatCr�i.Lcit 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 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 tTremie ❑Other: Type of Method: <br /> Water Cement 4716 Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest ags Thickest Thinnest t►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 1 40 80 8 <br /> (E) vo/ 10/16/2017 <br /> r <br /> 1868 E. Hazelton Avenue e I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />