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SA N,J OA Q U I N Environmental Health Department <br /> l — . COUNTY-- <br /> �`cQ.4FoaN�P%' Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:7jLtl2j Inspector: LG'r7Ci CONSTRUCTION <br /> Facility Address: G <br /> Well Address: Total Depth: bG <br /> WP# 2500�58 Well#: Q �G I Drilling Rig Type: (7�t <br /> Soil Boring#: <br /> Cx�GC�✓t�✓r Min 2" Annular EHD Seal Verified: CYes I ❑No <br /> Drilling Company: o <br /> Driller Onsite: Vl&w"-%wl Screen Length From: To: 7 <br /> Consultant: + 41 cC,LJ Filter Pack From: (/ � To: —'LG <br /> Geologist: vV ,^CSC Bentonite From: To: n(6 Cll <br /> Grout From: 6.Cl' To: 5%4/4CC <br /> Public Water System Onsite: ❑ Yes []No COMPLETION ❑ Stove Pipe '4hristie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: 311 <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLETION coti+m noN <br /> Method: GroundSurfacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> tt. <br /> SPOILS = <br /> o <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes, spoils storage Location: alott� <br /> .on 3 = <br /> Covered: ❑ Yes ❑No = ¢­4 i <br /> If yes, material: 'x <br /> GROUTING or DESTRUCTION Total Depth: (26•C1 I <br /> Depth to Water: 33 1 <br /> Grout Material: V7[ok CPwtpv%h <br /> Gallons of Grout Used: V3o a"k MATERIALS DEVELOPMENT <br /> Casing Type: <br /> *yell Installation ❑Well Destruction Blank_ !;S Feet Screen 72- Feet <br /> ❑Boring Installation El Boring Destruction Slot Size: A P 10 <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: Z• bS <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity T*Jremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> gall Bags gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest :1 Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 /> 20 40 8 40 80 8 <br /> IL-1 ��� 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 />