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SAN. JUAUUIN <br /> —COUNTY— Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: AM MS Inspector: CONSTRUCTION <br /> Facility Address: <br /> Rxl� <br /> Well Address: Total Depth: _ <br /> WP# �(/ 'z, � �ci _Well#: /�11�1,'- '7 Drilling Rig Type: P110 <br /> Soil Boring#: �_ <br /> Drilling Company: Min 2" Annular EHD Seal Verified: 12/Yes El No <br /> L/�SG�f��, A � To: <br /> Driller Onsite: ��f•},Q,�, <br /> Screen Length From: <br /> Filter Pack From: To: <br /> Consultant: Pj,�vc,�L17 J-} 55 OC . �- �— <br /> Geologist: ;'b(; 6,p,c't, �C„F} <br /> Bentonite From: Jr. l To: <br /> ZN <br /> Grout From: �� To:Public Water System Onsite: ❑ Yes o COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ZYes ❑No casing <br /> If yes, location and distance: too height <br /> SAMPLING ABOVE-GROUND C*Rmw_ <br /> Holding Temperature: COWPLETION COMPPLE71oN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> I tt. <br /> Verified Chain of Custody: ❑ Yes ❑No ft <br /> b n. _ <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes ❑No a: <br /> If yes, spoils storage Location: rA <br /> o <br /> atottad <br /> axtion <br /> Covered: Yes ❑No = gw P <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: cl (1 <br /> Depth to Water: _ �l� `U fL n <br /> Grout Material: 0 fl- T <br /> Gallons of Grout Used: MATERIALS DEVELOPMENT <br /> Casing T pe: 416 <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen -CO Feet <br /> Slot Size: �• �c- U <br /> ❑ CBoring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ��// Type/Brand of Bentonite: <br /> ❑Pressure Grout E30ver Drill Filter Pack Type/Size: <br /> ❑ Gravity dremie ❑Other: Type of Method: <br /> Water Cement 47lb water Cement 941b <br /> gallons Bags gallons 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 /> 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 7 35 70 7 <br /> 20 A 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www•sicehd.com. <br />