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SAN 10AQUIN Health <br /> Environmental Department <br /> -COUNTY- \, 6 f ) `` y <br /> Monitoring Well/Soil Boring Inspection Report l/' obSevwe94 beP <br /> Date: la ►I d Inspector:C► Ru'f �l(<<�Gi CONSTRUCTIONbw <br /> J <br /> Facility Address:)GS) Gre,>1 tV Llht I <br /> Well Address: Total Depth: J <br /> WP# L')0019i Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> �c/ P ��> 1 Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller Onsite: AI'F ( <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 1:1 No casing <br /> If yes, location and distance: height <br /> ­ww' <br /> SAMPLINGABOVE-GROUND <br /> Holding Temperature: cowPLEriON COOM�M�oN <br /> Method: Grwnd5urfecs"+ <br /> Screening Method: c�«n <br /> Verified Chain of Custo y: Eles ❑Noft. <br /> ft. <br /> ft. <br /> SPOILS <br /> _ o <br /> Contamination Noted: 't' n Y El No <br /> If yes,spoils storage Location <br /> slotted <br /> sacaan "— <br /> Covered: nes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n- n' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ABoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity [�Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas vallons Bags <br /> Thickest Thinnest PBags Thickest Thinnest xBags Bentonite/Cement Mix 3% Mix 3%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 /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />