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SAN aJ0A Q UIN <br /> Environmental Health Department <br /> ) COUNT Y— <br /> s <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> 1a 2t3 St���rez{ IiP- (2 15 <br /> Date: Inspector:��,�_ ,. , CONSTRUCTION 12 G <br /> 28 <br /> Facility Address: .WOk VUAX al t�UWl l2-' 2-q I <br /> Well Address: Total Depth: <br /> WP# ©o qD Well#: Drilling Rig Type: <br /> Soil Boring#: i t — 12,b + 1 26, 12--1 Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: COLS Q <br /> Driller Onsite: i Screen Length From: To: <br /> Consultant: Alckrinv Filter Pack From: To: <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 ❑No casing <br /> If yes,location and distance: I. HT <br /> t <br /> heigh <br /> MY W- <br /> SAMPLING ABOVE-GROUND QiRmw-eox <br /> Holding Temperature: COMPLETION CCMPLE ON <br /> Method: ereurd suiacv <br /> Screening Method: Groin <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> n. <br /> SPOILS <br /> a <br /> Contamination Noted: ❑Yes ❑No —_ e <br /> If yes,spoils storage Location: alonoa . . <br /> sac9on � = 8 <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:27r29/ <br /> Depth to Water: 24 :-1 , 2 3127, 2ti d ft• — ft. <br /> Grout Material: Kkat C2 y✓I." MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation- Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity bkremie ❑Other: Type of Method: <br /> Water Ceinent 471b Water Cement 941b <br /> allons Rao allons Bags _ <br /> Thickest Thinnest agz Thickest Thinnest 4889s _ Bentonite/Cement MIX 3%MIX 5%MI <br /> 2.5 5 1 5 10 1 Bentonlle er47lb 1.41 2.471_ <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4. <br /> 7.5 15 3 15 30 3 - <br /> 30 20 4 20 40 4 <br /> 12.5 25 s 2.5 50 5 �tan.e}e Y — LA frrm <br /> 15 30 6 30 60 6 c ___ <br /> 17.5 35 7 35 70 7 i ,15 1�Dr✓V 5 - 111D+A-6 Vt, <br /> 20 40 a 40 80 e <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton. California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />