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SAN_dOAQUIN Environmental Health Department <br /> ---COUNTY <br /> Greatness grows hetc <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 3_117Md Inspector: �ITAO CONSTRUCTION <br /> Facility Address: /3S7z_ /3d/Wwk, <br /> Well Address: Total Depth: <br /> WP#mW>y.� Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Company: �/ �I Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling P y:/a.,e�2 <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 21go COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: l3 Yes ❑No <br /> casing <br /> If yep, location and distance:.Sr't /--Ar~'4 <br /> IffT height <br /> �� �r lbw• �. <br /> SAMPLING ABOVEGROUND <br /> Holding Temperature: CONFLET ON C�tFnoN <br /> Method: Ground Sudaas <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft' <br /> tt. <br /> tt. <br /> SPOILS = .: <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted <br /> an <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> a <br /> GROUTING or DESTRUCTION Total Depth: 3G0 : <br /> Depth to Water: tt. = tt. <br /> Grout Material: 2­e> Q PK +�»�'ft- scs S MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> ,.� Casing Type: <br /> MWell Installation ❑Well Destruction ZZ �d !�l Blank Feet Screen Feet <br /> '' +1�G flu /Sags Slot Size: <br /> ❑Boring Installation ❑Boring Destruction (/ Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> S�,jor.1.(GKS Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill 1+2-0 t/a«!. <br /> .60 Filter Pack Type/Size: <br /> ❑ Gravity Pfremie ❑Other: e� Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas vallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest 4Bags 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 /> 10 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 />