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= c°G SAN�JMUIN <br /> Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 3�11� Inspector: /- 91:1 2 CONSTRUCTION <br /> Facility Address: �Ulv���A�:,. 11 <br /> Well Address: Total Depth: <br /> WP# t ,o !I.0 C'\ Well#: Drilling Rig Type: <br /> Soil Boring#: Q,' I Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: M urtr <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: <br /> Filter Pack From: To: <br /> Geologist:T , <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GRpILINp <br /> Holding Temperature: cokrLErJON aAPtFnoN <br /> Method: GramdSur(a" T <br /> Screening Method: Grout— <br /> Verified Chain of Custody: El Yes ❑No n• <br /> ft. <br /> ft. <br /> SPOILS <br /> = ' e <br /> Contamination Noted: ❑ Yes ❑No <br /> Al <br /> if yes, spoils storage Location: slotted c. <br /> Covered: ❑ Yes ❑No �� <br /> aS; = g.,;W pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: -74- <br /> =_ <br /> Depth to Water: n• — n• <br /> Grout Material: Aea4 1'c4j'a'a/- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> Goring Installation Moring Destruction Bags Slot Siziz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> KI Gr vity . ❑Tremie ❑Other: Type of Method: <br /> rlilr 01-11 <br /> Water Cement 47 lb Water Cement 941b <br /> gallons Bags gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% 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 /> ,Lys, 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 />