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SANo�OQQUIN ,) Environmental Health Department <br /> —COUNTY— <br /> `.°�_",��,�^° Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 10 Q 1 1 Inspector: CONSTRUCTION <br /> Facility Address: S t4oLA, <br /> Well Address: r1tvi t. U, !Ii utu" -w Total Depth: <br /> WP# 0o1$'itA Well#: U1 -ZgrP.-MIR Drilling Rig Type: 5bw c. !21 <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller Onsite: _R ado <br /> Filter Pack From: To: <br /> Consultant: La.wrlvlw <br /> _C'UnIrlS Bentonite From: To: <br /> Geologist: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: f height <br /> SAMPLING ABOVE-GROUND C*11R*i'-Box <br /> Holding Temperature: cowLETION COMPLEnON <br /> cu«;nd swrxa 7•- <br /> Method: 4 <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes ❑No —� <br /> ta. <br /> SPOILS <br /> o ' <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: Llpltod 'A <br /> a<cIon e: = <br /> Covered: ElYes ❑No <br /> If yes, material: — <br /> GROUTING or DESTRUCTION Total Depth:.. PIR <br /> Depth to Water: TO 5 <br /> Grout Material: N_ # MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: // Casing Type: <br /> ❑Well Installation LHWell Destruction 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 Grouts DOver Drill Filter Pack Type/Size: <br /> ❑ Gravity M remie ❑Other: Type of Method: <br /> Water Cement471b Water CementMb <br /> all°ns Bags all Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags 8entoni e:/Cement Mix 3°!° Mix 5°ta MiX <br /> a5 s 1 s m 1 Bentonite per 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 lib 1 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 5 <br /> 17.5 35 7 35 70 7 <br /> 20 40 0 1, 40 30 B <br /> 10/16J2017 <br /> ,1 65 14f'J!N' tlrl t z h7 � 1Lb <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T' 209 468-3420 1 F 209 464-0138 1 wvvw.sicehd.com <br />