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�'- <br /> !�' <br /> •� �, , :� SANAOAQUIN Environmental Health Department <br /> —coUNTY— <br /> �,rE' l <br /> GI'P.OI nP.35 9fOW5 here. <br /> 0/ Monitoring Well/Soil Boring Inspection Report <br /> Date: ��'ID! & Inspector: c1�" )�J CONSTRUCTION <br /> Facility Address <br /> Clc.i f-G � <br /> : Eon' <br /> Well Address: Total Depth: <br /> WP# oa a Well#: n✓-f Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ElYes ❑No <br /> DrillingCompanV !.5 2 <br /> Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: &L A tiS Bentonite From: To: <br /> Geologist: -Otill Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> j� <br /> If yes,location and distance: height <br /> SAMPLING AWVS-i;flouNo p BOaN <br /> cowLffrioN <br /> Holding Temperature: Grounds rxa <br /> Method: <br /> grout <br /> Screening Method: <br /> �ft. <br /> Verified Chain of Custody: ❑ Yes ❑No tt. <br /> SPOILS a <br /> Contamination Noted: ❑Yes ❑No — <br /> If yes,spoils storage Location: alottad — <br /> aae5on <br /> Covered: ❑ Yes ❑No _ yraval Pack <br /> If yes, material: — <br /> GROUTING or-DESTRUCTION Total Depth� - <br /> =... <br /> — tt. <br /> Depth to Water: --10 z <br /> Grout Material: Cw( certe+lr MATERIALS/DEVELOPMENT <br /> u <br /> Gallons of Grout Used O fj Casing Type: <br /> ❑Well Installation .dell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> �� <br /> ❑ Gravity �ISLTremie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 941b <br /> all°ns Ba zMin <br /> Ba s <br /> Thickest thinnest 00ags est 11Bags BantonitelGementMix 3%Mix 5°!° Mi:c <br /> 2s s 1 1 Bentonite per471b 5 i0 2 z Bentonite er 94lb 2.82 4.7 <br /> 75 15 3 330 20 4 412.5 25 5 515 30 6 - 617,5 35 7 720 40 8 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />