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p,CUrry'-. <br /> rz'°%�,c�`2� SAN.AAQUIN Environmental Health Department <br /> 1. /11 —COUNTY— <br /> ,�cciPf Greatness grows here. <br /> MwUro,�itoring Well/Soil Boring Inspection Report <br /> Date: Inspect r. CONSTRUCTION <br /> Facility Address: M <br /> Well Address: [Al I L44/Total Depth: <br /> WP# a 41 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: _ Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: C Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> 8 a� <br /> Geologist: AA <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWF�1ON ccOOMP�LEnoN <br /> Method: °roan°Surpass <br /> Screening Method: ora,t <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> tt. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: .bid <br /> sae2an <br /> Covered: ❑ Yes ❑No = gravl+Pock <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 2 � <br /> Depth to Water: i lir,5 n• .� — tt <br /> Grout Material: /jq_at- ' `C MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: l�-_0 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation Boring Destruction <br /> Bags of Cement: <br /> METHOD USED <br /> � ls�/ ��rf' Bags Sand/Gravel: <br /> ❑ ❑ yType/Brand of Bentonite: <br /> Pressure Grout <br /> Over Drill NvVL'+' Filter Pack Type/Size: <br /> ❑ Gravity emie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest uBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 s0 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 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />