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SANIOAQUIN <br /> Environmental Health Department <br /> rL- —COUNTY— <br /> Greatness grows here. <br /> llJJ / MonitoringWell/Soil Boring Inspection Report <br /> Date: 2� II Ly Inspector:��6K CONSTRUCTION <br /> Facility Address: 600l 5. AUS�i 711 •, Srt°C Kto, <br /> Well Address: Total Depth: <br /> WP# &VI 161 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: 11 Yes ❑No <br /> Drilling Company: i 2 ZArth Geo, Screen Length From: To: <br /> Driller Onsite: jo 3 <br /> Consultant: 2SGl6L(e.- ktn �SSdCIG� � Filter Pack From: To: <br /> Geologist: c7o('y <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 AWVE-GROUND <br /> Holding Temperature: COMPLETION COMPLEMN <br /> Method: GcundSurface T <br /> Screening Method: gfOLl <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> tt. <br /> SPOILS <br /> a = a <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slorwd = - <br /> sacton <br /> Covered: ❑ Yes El No r: — <br /> '.r <br /> 9­1W pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: Q - � 3S ft , rnll G� heVS d�vN n. — tt <br /> Grout Material: E(A �P-tj 2— MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used a yj TVttn1— 60 jo.( Casing Type: <br /> e: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Borin Installation Slot Size: <br /> g8oring 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 /> ❑ Gravity �Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest 4 Bags Tfiiskest Thinnest s Bags Bentonite/Gement 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 I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />