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v SAN910AQUIN <br /> °�"� � Environmental Health Department <br /> —COUNTY— <br /> Greatness <br /> COUNTY—Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: D ��D (vl Inspector: CONSTRUCTION <br /> Facility Address: �a�65 S En'( a I /7V\C/ <br /> Well Address: Total Depth: <br /> WP# N):M 14 Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: W M ..`� <br /> --I�I' Screen Length From: To: <br /> Driller Onsite: n 341 <br /> Filter Pack From: To: <br /> Consultant: <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 El No casing <br /> If yes, location and distance: T height <br /> iii <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION COMP�LET1oN <br /> Method: G=nd Surfw* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> tt. <br /> ft. <br /> SPOILS <br /> Y — a <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: atoned = . <br /> on 'x — <br /> Covered: ❑ Yes ❑No = vow t <br /> ack <br /> If es material: — <br /> :.2! - <br /> GROUTIN r DESTRUCTION Total Depth: 200 <br /> Dept to Water: n• - n' <br /> Grout Material: alllIL (�IYD' 2()��oyCitl� >1 't77 <br /> Gallons of Grout Used: MA ERIALS/DEVELOPMENT <br /> Casing Type: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction 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 'yTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags 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 /> 1 25 5 25 so 5 <br /> 155 30 6 30 60 6 2(3 V J L A�'U`Q VvaZL`l' <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 209 464-0138 1 www.sicehd.com <br />