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SAN,IOAQUIN <br /> Environmental Health Department <br /> j COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: c 7117s' i Inspector: �.,��, �� (; �,`,. S(t,-� CONSTRUCTION <br /> Facility Address: <br /> Well Address: 7-13 S S1 &Ili c 1 Total Depth: <br /> WP# EC y 13 y j Well#: Drilling Rig Type: <br /> Soil Boring#: 1 -' 61 <br /> Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: i;L;4,.,E Li�,�i (xgla, �.�, o�, <br /> Driller Onsite: `l,krt,f' Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: -ftnc,,r. S�_r\v f.. <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 0 N casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-ORCX M <br /> Holding Temperature: COMPLETION CCOMPPLEnoN <br /> Method: Ground Surface <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> n. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No _ <br /> If yes, spoils storage Location: atottad <br /> s�c�on <br /> Covered: ❑ Yes ❑No <br /> Gravel Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: /S.GZ : <br /> Depth to Water: f — n- <br /> Grout Material: GPn MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation © Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> ! Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie I�Other: �" {nI I Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas oallons Bags <br /> Thickest Thinnest 'V Bags Thickest Thinnest VBags 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 /> 6" A,) .� r 4,5 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />