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SAN 10AQUIN Environmental Health Department <br /> —COUNTY-- <br /> Greulr,ess flows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: S(J�DYL CONSTRUCTION <br /> Facility Address: \S S. Irk. <br /> Well Address: Total Depth: <br /> WP# tiSo O5g�?- Well#: Drilling Rig Type: <br /> Soil Boring#: ,-t2o. SP'Z SIP } SP'tb) 5P2y0 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: V7 S e,kq,\a . LL-G <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: CwA u►` g:0:j�e"k\,l,l.0 <br /> 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 El No casing <br /> If yes,location and distance: height <br /> SAMPLING AMVE-GROUND CN8Mw-80X <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: G=nd Saf ace <br /> Screening Method: Qrout <br /> Verified Chain of Custody: ❑ Yes El No L�ft. <br /> n. <br /> —ft. <br /> SPOILS 41_ — <br /> — a <br /> Contamination Noted: ❑Yes El No = JR <br /> If yes,spoils storage Location: <br /> sac'on µ <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 3 iJ.S 1%4 Sl 20I <br /> Depth to Water: ,N((i,N-w . <br /> Grout Material: Oe-a tt CjCn)An - <br /> Gallons of Grout Used: tS, � U. -4 �(p MATERIALS/DEVELOPMENT <br /> r ��— Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation Destruction gags 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 JeTremie ❑Other: Type of Method: <br /> Water ent 4711 <br /> Water Cement 941b <br /> gallons Ba s gallons Bags <br /> Thickest Thinnest Thickest Thinnest tlBags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 2.5 5 1 ✓ 5 10 1 Bentonite per 47 lb 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.821 A 7 <br /> 7.5 15 3 ✓ 15 30 3 <br /> 10 20 4 v 20 40 4 <br /> 12.5 25 5 ✓ 25 50 5 <br /> 15 1 30 6 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 1 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 />