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SANIOAQUINO <br /> Environmer* Health e a en <br /> , <br /> —COUNTY— <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2S ® Inspector: CONSTRUCTION <br /> Facility Address: %?% <br /> Well Address:M00 K} Total Depth: <br /> WP# ? Well#: Drilling Rig Type: <br /> y:Ems. Ex—®2t <br /> Min 2"Annular EHD Seal Verified: ElYes El No <br /> W W Screen Length From: To: <br /> Filter Pack From: To: <br /> ®® entonite From: To: <br /> rout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 1:1 No casing <br /> If yes, location and distance: height <br /> M . <br /> SAMPLING 6ROUND <br /> Holding Temperature: CONPLETION COMPLETiON <br /> Method: Ground Surfw* <br /> Screening Method: govt <br /> Verified Chain of Custody: ❑ Yes ❑No • <br /> tt. <br /> t:. <br /> SPOILS = <br /> F = w <br /> Contamination Noted: ❑ Yes El No a; <br /> If yes,spoils storage Location: s' <br /> stonad <br /> aacaon <br /> E <br /> Covered: ❑ Yes El No <br /> EE g--1 Pack <br /> If yes, material: <br /> . <br /> GROUTING or DESTRUCTION Total Depth: f , <br /> Depth to Water: - - <br /> Grout Material: v C MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:~7h Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity remie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest pBags 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 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 Stockton, California 95205 ( T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />