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SAW- JQ•AQUIN <br /> Environmental Health Department <br /> COUNTY <br /> � rasty v jure. <br /> Monitoring Well /Soil Boring Inspection Report <br /> Date : Inspector : U �'� ; G � ` CONSTRUCTION <br /> Facility Address : ZUZ<S Vt <br /> Well Address : Total Depth : <br /> WP#" qZ319Well # : Drilling Rig Type : <br /> Soil Boring# : -- <br /> Drilling Company : � V Min 2" Annular EHD Seal Verified : ❑ Yes El No <br /> Driller Onsite : Screen Length From : To : <br /> Consultant : C6 Filter Pack From : To : <br /> Geologist : Bentonite From : To : <br /> Grout From : To : <br /> Public Water System Onsite : ❑ Yes F1 No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes ❑ No <br /> casing <br /> If yes, location and distance : eight <br /> SAMPLING AWyE�GROUyg <br /> Holding Temperature : col .;=r�N <br /> Method : GrodbdsLwfa' - <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes ❑ No f- <br /> #t. fL <br /> SPOILS <br /> Contamination Noted : ❑ Yes ❑ No <br /> If yes , spoils storage Location : :3itgd wr <br /> Covered : ❑ Yes ❑ No <br /> If yes, material : <br /> GROUTING or DESTRUCTION Total Depth : 6 � YJwf5 k <br /> Depth to Water : 204,E C e'�^.c- 6 ,,-�ti� � ''gf \ :r - <br /> Grout Material : Q. 'e, t _MATERIALS / DEVELOPMENT <br /> Gallons of Grout Used : •'`- ,SO G U 't <br /> � 0 ^ •� Casing Type : <br /> [] Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> ❑ Boring Installationoring 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 /> Qallons ' Bags oallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest rlBags Benton ite/CPtinent mix 3 % Mix ,5efn mix <br /> --- -------------------- ------- - --- <br /> M 5 s2 <br /> 10 1 Ctlio� nHe per 47 ib 1441 24 - i` <br /> 5 10 z 10 +40 <br /> 20 2 Bentonite per 94 Ib . 82 4 . 7 <br /> 7. 5 15 3 1530 3 ; <br /> 10 20 4 20 4 <br /> 12. 5 25 5 2550 5 <br /> is 30 6 30 60 6 <br /> 17. 5 35 7 35 70 7 <br /> 20 40 18 40 80 8 <br /> 10/ 16/2017 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209468 -34201 F 209464-0138 www. sicehd . com <br />