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P,° " SAN��J0A0UIN Environmental Health Department <br /> so. �o <br /> e <br /> t COUNTY <br /> eq<< rj Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7-51-2cO-' Inspector: A� E� CONSTRUCTION <br /> Facility Address: /6Y15'11V w,-, 14 Cd+jo^9,1( <br /> Well Address: Total Depth: <br /> WP# QQy/ao 7 Well#: Drilling Rig Type: 451"-Ie- <br /> Soil <br /> SISoil Boring#: del — DS' <br /> Drilling Company: '�� Kl Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> r,til< Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Leve- L Filter Pack From: To: <br /> Bentonite From: To: <br /> ` �...Y 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 /,ROVE-GROUND <br /> Holding Temperature: tOty LET10N GOMP EMM <br /> Method: Ground Sumacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No = <br /> If yes, spoils storage Location: stood <br /> asc:on <br /> Covered: ❑ Yes ❑No = v <br /> If yes, material: b�z � <br /> GROUTING or DESTRUCTION Total Depth: 15 __ <br /> IF <br /> Depth to Water: ND G n��w� �sr n• n' <br /> Grout Material: /Veae! eew,w 1L MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> �� Slot Size: <br /> ❑ R <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 /> C?'*'Gravity ❑Tremie ❑Other: Type of Method: <br /> poQhT-47 water Cement 941b <br /> all s Bas gallons Bags <br /> Thickest Thinnest tteags Thickest Thinnest ttBags 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 1 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 /> r^,(IV v5 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www,sicehd.com <br />