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° r°Gyp SAN ) UAQUIN • <br /> Environmental Health Department <br /> N � COUNTY <br /> X0o. 4 Greatness grows here . <br /> < 1Fa��- <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : v �% G inspector : � n;�^ =7 CONSTRUCTION <br /> Facility Address : <br /> Well Address : U ;\tUoe\ 7 ; , 1 SL s4itkio -\ Total Depth : <br /> WP #��C� i.j (� ( 3 Well # : �� t;� � � Drilling Rig Type : <br /> Soil Boring# : Min 2 " Annular EHD Seal Verified : ❑ Yes El No <br /> Drilling Company : C41 ? ITco ^ , 4. , 4 <br /> Driller Onsite : Screen Length From : To : <br /> , � J L�� Filter Pack From : To : <br /> �1i ; <br /> Consultant : A , . ,,, � i (.' , <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 El No casing <br /> If yes , location and distance : height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature : COMPL..E WON CrHR TY`8ox <br /> COMPLETION <br /> Method : Grwnd surra <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes 11 No ft- <br /> ft. <br /> ft . <br /> SPOILS - <br /> -" a <br /> Contamination Noted : ❑ Yes El No <br /> If yes , spoils storage Location : <br /> slotted :. <br /> sacion "_ <br /> Covered : ❑ Yes ❑ No '` — <br /> :u '— vxvel Pack <br /> If yes , material . <br /> GROUTING or DESTRUCTION Total Depth : to <br /> Depth to Water : _r_r___ ft. — IFtt. <br /> Grout Material : _ h !�- Ugo^� VA :, -fir bmh � <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 ❑ 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 ❑ Tremie ❑ Other : Type of Method . <br /> Water Cement 471b Water Cement 941b <br /> Rall s Bas allons Bags <br /> Thickest Thinnest # Bags 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 /> s 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 /> 1745 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/ 16 / 2017 <br /> 1868 E . Hazelton Avenue l Stockton . California 95205 1 T 209 468 - 3420 1 F 209 464 - 0138 1 www . sicehd . com <br />