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SAN JQAQU Environmental Healin Department <br /> COUNTY- <br /> Monitoring <br /> OUNTY-Monitoring Well/Soil Boring Inspection Re?ort <br /> Date: �� Inspector: VJ v, CONSTRUCTION <br /> Facility Address: "T ' _ ,.j�, (�Li <br /> Well Address: 4/(rat► � °'S� ('rf ;Total Depth:L!y <br /> WP# Well#: is 1/v CLE�j Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: Yes ❑No <br /> Driller Onsite: Screen Length From: To:� <br /> Consultant: {'� Filter Pack From: To: f�� <br /> Bentonite From: To: (Z <br /> Geologist: — i <br /> Grout From: Z. To: o <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe `Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing y <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLEMN COW=CN <br /> Method: G=nd Suriacs <br /> Screening Method: groLA <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> SPOILS = <br /> = m <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: stottoe <br /> aeon — <br /> Covered: ❑ Yes ❑No <br /> If yes, material: 7 — <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: Ce LS�a �� <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: ?y c t 5�'G ACX �-1 <br /> ell Installation ❑Well Destruction Blank Feet ScreenFeet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: AVOKKI, 144 . <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: �tnQ Scti. <br /> El Gravity FN remie ❑Other: Type of Method: -w(cD I� <br /> Water Cement 471b water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest PBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 N20 <br /> 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 30 3 <br /> 10 20 4 40 4 <br /> 12.5 25 5 50 5 <br /> 15 30 6 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 1 40 80 8 <br /> 'ZZ05 L,r �� 3/4 b� gr, 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />