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SAN 10A U I N <br /> Q Environmental Health Department <br /> `J -- COUNTY- <br /> C'qL/FOP�`P <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> �f <br /> Date. vW71QInspector: (, A CONSTRUCTION <br /> Facility Address: —9z S <br /> Well A dress: a Total Depth: PSA :C <br /> W P# Well#: Drilling Rig Type: lr l S A ' <br /> Soil Boring#: <br /> Drilling Company: A Q --� e-'n Min 2" Annular EHD Seal Verified: E] Yes 11 No <br /> Driller Onsite: J Screen Length From: To: <br /> Consultant: a 11/7 U Filter Pack From: To: <br /> Geologist: <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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLETION LEnoN <br /> Method: Ground Surface <br /> Screening Method: Lizgrout <br /> Verified Chain of Custody: ❑ Yes ❑No -�--n' <br /> ft. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: atoned <br /> on <br /> Covered: ❑ Yes ❑No ( _ anve+t� <br /> If yes, material: 1J � <br /> GROUTING or DESTRUCTION Total Depth. –! � 23 • __ <br /> Depth to Water: ' M n' <br /> Grout Material: <br /> Gallons of Grout Used:�� <br /> MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation []Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring InstallationBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> XGravity ❑Tremie ❑Cit her: Type of Method: <br /> Water Cement 471b Water Cemen 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #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 40 80 8 <br /> '��9 al 5 U Q 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 20468-3420 1 F 209 464-0138 1 www.sicehd.com <br />