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Health Department <br /> S A N ;J0A0UIN Environmen3_.. <br /> —COUNTY— <br /> Greatness grows here. <br /> 1 Monitoring Well/Soil Boring Inspection Report <br /> Date:ii Z\v1p Inspector: CONSTRUCTION <br /> Facility Address: q)\QoV N4&1k�R" Total Depth: <br /> Well Address: <br /> WP# `AtpW3 Well#: l?�y• 05 '� Drilling Rig Type: <br /> Soil Boring# t 1 W Min 2"Annular EHD Seal Verified: El Yes ONO <br /> Drilling Company: r �•c Screen Length From: To: <br /> Driller Onsite: l c. &;S:i� Filter Pack From: To <br /> Consultant: P.zL• Bentonite From: To <br /> Geologist: 9t1��J�' Grout From: To: <br /> Public Water System Onsite: kkYes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: El QAIo -t ITT casing <br /> height . <br /> If yes,location and distance: <br /> ABOVE4 OUND Owsm-BOX . <br /> SAMPLING �\� CowPLErION cotevtE119N <br /> Holding Temperature: c<u msu taw. <br /> Method: gran <br /> Screening Method: <br /> Verified Chain of custody: ❑Yes ❑No tt• <br /> SPOILSsi <br /> = z <br /> E <br /> Contamination Noted: <br /> ❑Yes ONo :A. = � <br /> alotmd ` = <br /> If yes,spoils storage Location: ON���- a.rion �".7 3 <br /> Covered: I)LYes ❑No = oAwal pack <br /> If yes,material:GROUTING <br /> a— <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation 'Okweli Destruction <br /> Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout qOver Drill Filter Pack Type/Size: <br /> ,,L Type of Method: <br /> El Gravity LNTremie ❑Other: <br /> Water ` Cement 471b Water Cement 941b <br /> allons Ba s allons Be s <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags _ BentonitelCement MIX 3% MiX 5% MiX <br /> Bentonite per 41 Ib 1.41 2.47 <br /> 2.5 5 3 5 10 1 2.82 4.7 <br /> 5 10 2 10 20 2 Bentonite per 94lb <br /> 7.5 15 9 15 30 3 <br /> 10 20 4 20 40 4 <br /> 1215 25 5 25 50 5 <br /> 15 0 6 30 60 6 <br /> 17.5 7 35 70 7 <br /> 20 40 s 4o eo e 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 cam <br />