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SANr10AQUIN Environmental Health Department <br /> —COUNTY— <br /> ',:;,a= Gr-ectness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:�U��Inspector: CONSTRUCTION <br /> Facility Address.'U , 2"1 "\ `L�2'S 5''m �o� S7 <br /> Well Address: N)_&� lPsS Total Depth: <br /> WP#,,k�\��; i titi 1 %3 Well#: /4k- Drilling Rig Type: <br /> Soil Boring#:��- ,(�2�3 � I gIO I�� Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company:�,acG�r f �P.`aT �;'<Q���.�Pc_VoO <br /> Driller Onsite: Z•Pc c.� Screen Length From: To: <br /> Consultant: �C ,��_► P =sQ-4� 'c.r�Q� .`-I Fier Pack From: To: <br /> Geologist:�0.�>�-c `. Ben onite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes [ANo, COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: Yes ❑No casing <br /> If yes, location and distance: T height <br /> SAMPLING IJ i gyp, ABOVE-GROUND <br /> corr�i�noN c�ss-rY-aox <br /> Holding Temperature: c w EriotJ <br /> Method: Gr wnd Sutacs <br /> Screening Method: 16� gro`A <br /> Verified Chain of Custody: ❑ Yes ❑No 021ft' <br /> ft. <br /> ir. <br /> SPOILS <br /> z <br /> Contamination Noted: ❑ Yes PNo <br /> If yes, spoils storage Location: <br /> / sacIon w = <br /> Covered: ❑ Yes )1No ; > <br /> If yes, material: mss. .= <br /> GROUTING or DEST UCTION Total Depth:'ZO \S U <br /> Depth to Water:43 1 kis fL IF <br /> x' <br /> Grout Material: ts <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <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 ❑Tremie ❑Other: Type of Method: <br /> / Water Cement 471b Water Cement 94 lb <br /> gallons Bas gall ons Bags <br /> Thickest Thinnest it Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 209 464-0138 1 www.sicehd.com <br />