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SAN 10AQUIN <br /> Environmental Health Department <br /> ` -- -COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ftl nspector: b,,—,- x- 4- CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: C A 4 yi <br /> WP#()(DLI 11 :55 Well#: Drilling Rig Type: J1J <br /> Soil Boring#: 19 1 9;_ Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: '�Pi1�Ya LOIS! Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 1:1 No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETiON COMP�LET1oN <br /> Method: around Surlwe <br /> Screening Method: or«a <br /> Verified Chain of Custody: ❑ Yes ❑No ir —n' <br /> n. <br /> n. <br /> SPOILS <br /> � w <br /> Contamination Noted: ❑ Yes ❑No _ <br /> If yes, spoils storage Location: <br /> slaned ; — S <br /> 2 ..c�.n <br /> Covered: El Yes ❑No = graw+ip-�k <br /> If yes, material: 62 ' 15 <br /> If <br /> GROUTING or DESTRUCTION Total Depth: 35 -F�' -__ <br /> IF <br /> Depth to Water: n' <br /> Grout Material: <br /> Gallons of Grout Used: ti o2(o Q N� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring InstallationXBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cemen 471b Water Cement 94 lb <br /> allons Bas lRallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 9Bags 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 /> X20 cil bap 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 />