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SANARQUIN <br /> - Environmer ' Health Department <br /> —COU NTY— <br /> ;;:,.,;_ ' Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7i Inspector: t1 CiA CONSTRUCTION <br /> Facility A dr ss: Gjy� , <br /> , �QXdg <br /> Well Address: S,�.ti rI Total Depth: <br /> WP Aj�UU �Z Well#: Drilling Rig Type: <br /> Soil Boring#: _ Fj 4, <br /> Drilling Company: Min 2 Annular EHD Seal Verified: [I Yes ❑No <br /> Driller Onsite: - Screen Length From: To: <br /> ((�� Consultant: Filter Pack From: To: <br /> Geologist: nUf(_ Bentonite From: To: <br /> VV Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING <br /> .�sov>=-�aouNo <br /> Holding Temperature: GONFLETION cNAisn BOX <br /> COMPLETIt7N <br /> Method: c�«;nas�rrx. <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> SPOILS ft. - —_ <br /> Contamination Noted: ❑ Yes ❑No = m <br /> If yes,spoils storage Location: <br /> :Iottrd — <br /> sac'on = <br /> Covered: ❑ Yes ❑No <br /> If yes, material: < - <br /> GROUTING or DESTRUCTION Total Depth:_ - - <br /> Depth to Water: ft. = ft. <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑WeII.Des ruction Blank Feet Screen Feet <br /> ❑Boring Installation Slot Size: <br /> 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 /> gallons Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags 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 /> S <br /> 1868 E. Hazelton Avenue Stockton,C lifornia 95205 I T 209 468-3420 1 F 209 464-0138 I, www.sicehd.com <br />