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)OAQUIN SAN <br /> � Environmental Health Department <br /> i —COUNTY <br /> "'�:4 t. Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: g/c%E Inspector: t-rol F,-oeof CONSTRUCTION <br /> Facility Address:1K�S;q ra: &rc.t L. Rt>( nwC4 7jra0c� <br /> Well Address: 1C w'. Lrc,�Lvrfi,,wt� 4s3c`! Total Depth: <br /> WP# Well#: Drilling Rig Type: (Zey6-,s e <br /> Soil Boring#: <br /> Drilling Company: Ch tLlc/o„cMin 2"Annular EHD Seal Verified: (] Yes ❑No <br /> il�4 <br /> Driller Onsite: Ef -Z C; Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: 7i` To: r;rt_,lti <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 /> ITTLT <br /> - M ff__ <br /> SAMPLING ,+gpyg.GgOUND <br /> Holding Temperature: COWLErION COMPLEnON <br /> Method: G=ndSLxf=s + ` <br /> Screening Method: 51111 or«n <br /> Verified Chain of Custody: ❑ Yes []No �ft. <br /> ft. <br /> ft. <br /> SPOILS . <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: aton,:d <br /> sacdon <br /> Covered: ❑ Yes ❑Nog-101 Pack <br /> = <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:-76,L, - <br /> Depth to Water: n• ' <br /> Grout Material: 5e�ine4 Cir^e' <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: �4e�y '7ot, Casing Type: <br /> XWell Installation ❑Well Destruction Blank Feet- Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Z`75o, 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 Cement 47 lb Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest uBags 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 vwvw.sicehd.com <br />