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f °�. SANADAQUIN <br /> 1„ t-a."i:-�J —COUNTY— <br /> Greatness Environmental Health Department <br /> grows here. <br /> Monitoring Well/Soil Boring Inspection Report: <br /> Date: 2-1 Inspector: Imo_ CONSTRUCTION <br /> Facility A dress: _ 5'r <br /> Well Address: Total Depth: <br /> WP# D bq 4 25S Well#: Drilling Rig Type: <br /> Soil Boring#: RUj t Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling company:Driller Onsite: Screen Length From: To: <br /> utu <br /> Consultant: Filter Pack From: To: <br /> Geologist: TTLt&o 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 <br /> casing <br /> If yes,location and distance: jm_ nesyrst <br /> SAMPLING aeove dRWNO <br /> Holding Temperature: O0hOLEr10N cCWPLir:` qN <br /> Method: c3roiraSwlaa �— —�' <br /> Screening Method: Oront <br /> Verified Chain of Custody: ❑Yes ❑No �ft• <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: .t n d <br /> B <br /> Covered: ❑Yes ❑No att5on <br /> WZVW Pack <br /> If yes, material: u <br /> GROUTING.or-DESTRUCTION.Total Depth:--2M.- <br /> Depth to Water: ft tt• <br /> Grout Material: _iyeo-N- C,eW_rL+ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: '1� Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation C3Boring Destruction 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 /> J&Gravity ❑Tre i ❑Other: Type of Method: <br /> Water ment 471b Water Cement 941b <br /> allons eallons Ba s <br /> Thickest Thinnest gs Thickest Thinnest kBags BentoniteXement Mix 3% MIX 5%MIX <br /> 2.5 5 1 s 10 1 Bentonite per47lb 1 1.411 2.47 <br /> 5 10 2 10 20 a Bentonite per 94lb 2.82 4.7 <br /> 715 15 3 35 90 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 s 25 so s <br /> is 30 6 30 60 • 6 <br /> 17.5 95 7 35 70 7 <br /> 20 40 8 40 Bo a <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 />