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=as ing <br />11-- height <br />ABOVE-GROUND <br />COM:I-EDON <br />SANAAQUIN <br />COUNTY— <br /> Environment Health Department <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: lnspectq : <br />Facility A drsess: l'?Li6 <br />Well Address: <br />WP# 003t7S6, We I l#: vc <br />Soil Boring#: <br />Drilling Company: Nsi 41 (A.) v-i I i <br />Driller Onsite: ryttAA <br />Consultant: OrtILA e.ArD <br />Geologist: A yldirtAA,--- -Dov- <br />Public Water System Onsite: 0 Yes 0No <br />Domestic Well Onsite: 0 Yes DNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 0 Yes EINo <br />SPOILS <br />Contamination Noted: 0 Yes ONo <br />If yes, spoils storage Location: <br />Covered: DYes LINo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />4 Depth to Water: <br />Grout Material: Yks 0L+ CpArvV2ovvt" <br />Gallons of Grout Used: I 0 <br />OWell Installation Aell,Destruction <br />lii Boring Installation U Boring Destruction <br />METHOD USED <br />Pressure Grout 0Over Drill <br />0 Gravity ATremie 00ther: <br />water <br />gallons <br />Cem ent 471b <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest 4Bag Thickest Thinnest 4Bags <br />2.5 <br />q) <br />1 5 10 1 <br />5 2 10 20 2 <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 />"cliaffv\L46( <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes ElNo <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION 0 Stove Pipe 0Christie Box <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />CONSTRUCTION <br />10/16/2 017 <br />1868 E. Hezelton Avenue J Stockton, California 95205 209 468-3420 I F 209 464-6138 J vvvvw.sicehd.com