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SAN aTJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> _ Greatness yroivs here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: L(AA)_202'Z}nspector: CONSTRUCTION <br /> Facility Address: ,r�)a4a T_ � <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: 2 50�_V_ �ro�L1�'L <br /> Drilling Company: 6n f-- p -- �`I. Min 2"Annular EHD Seal Verifi d: El Yes ❑No <br /> Driller Onsite: CPsSr��--( . Screen Length From: To: <br /> Consultant: E� G.,�� Filter Pack From: To: <br /> Geologist: �_p��,G_ Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes C No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes �No <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLEN COMPLETION <br /> r10 <br /> Method: G=nd Sumacs <br /> Screening Method: 15� grout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt. <br /> tt. <br /> ft. <br /> SPOILS <br /> = a <br /> Contamination Noted: ❑ Yes []No ` <br /> If yes, spoils storage Location: stand <br /> sac5on = <br /> Covered: ❑ Yes ❑No 9,,,w <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:q�a� —_ <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: w Lj MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation/C�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 COTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 IT 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 Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />