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SANo710AQUIN <br />Environmental Health Department <br />—COUNTY <br />6r° Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: i{ 2, Inspector: InS" Ck-( CONSTRUCTION <br />Facility Address: ?-b R- F, CG06/oPo/if jtxKC'L' <br />Well Address: Total Depth: <br />WP#D Well#: Drilling Rig Type: <br />Soil Boring#: 13 1' Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Drilling Company: <br />Driller Onsite: Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: n;t-�t Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted <br />If yes, spoils storage Location:. <br />Covered: <br />❑ Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes []No <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water:GroutMaterial: <br />Gallons of Grout Used:MATERIALS/DEVELOPMENT <br />_//o °^� Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />Slot Size: <br />❑Boring InstallationK—Boring Des sof Cement: <br />METHOD USED G� roL-t to Bag and/Gravel: <br />Sr �1'brti Jw�%�� Type rand of Bentonite: _ <br />❑P/ressure Grout ❑Over Drill er Pack Type/Size: <br />,lel Gravity ❑Tremie ❑Other: Type of Method: <br />WT <br />easing <br />height ' <br />ABOVE-lbFICU D e4-(p1srY.6ox <br />COMPLETION COMPLETiON <br />Orncind Surfxs , <br />grout <br />ft. <br />ft. <br />ft. _ <br />.�31 _ o <br />0 <br />- o <br />stottad c <br />st�j,ion <br />! &T=om Pack <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />allons <br />Cernent 941b <br />Bags <br />Thickest Thinnest <br />2.5 5 <br />#Bags <br />1 <br />Thickest Thinnest <br />#Bags <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix. <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />' f <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 />