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f2. JAN.OUAQUIN Environmental Health Department <br /> —COUNTY— <br /> ` <br /> Greatness grows here. <br /> Monitorin el /Soil Boring Inspection Report <br /> Date: /��2 Inspector: CONSTRUCTION <br /> Facility Address: . <br /> Well Address: Total Depth: <br /> WP# Well#:A�ZA — Drilling Rig Type: <br /> Soil Boring#: E ' <br /> � _ Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: (/,�`�lA ��� <br /> Driller Onsite: , Screen Length From: To: <br /> �� �--� -� Filter Pack From: To: <br /> Consultant: GO�1N� N� P r!/! <br /> Bentonite From: To: <br /> Geologist: A56� <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes VNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes /No <br /> casing <br /> If yes, location and distance: height <br /> 17 <br /> SAMPLING /V j14 ABOVEGROLNn <br /> Holding Temperature: COWLET)ON CCOWLELETiON <br /> Method: Ground Sudacs <br /> Screening Method: procst <br /> Verified Chain of Custody: ElYes ❑No ' <br /> it. <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes /No <br /> If yes, spoils storage Location: - <br /> saCaon <br /> Covered: ❑ Yes /No — <br /> fPack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ZS - <br /> Depth to Water: /UIA <br /> ' <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 /> EJ Boring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity I Tremie ❑Other: Type of Method: <br /> Water Cement 471b 'Nater Cement 941b <br /> allons Bas gall ons Bags <br /> Thickes Thinnest » s Thickest Thinnest #Bags Bentonite/Cement MIX 3°7ro MIX 3% NIIX <br /> 2.5 s 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 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 209464-0138 1 www.sicehd.com <br />