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" z SANJOA UIN <br /> Q environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Dater Inspector: CONSTRUCTION <br /> Facility Address: 1�D <br /> Well Address: ON L 01,5 tL C !D Vb Q.Q, Total Depth: <br /> WP# � -� Well#: %) --A Drilling Rig Type: <br /> Soil Boring#: N I Min 2"Annular EHD Seal Verified: ❑Yes ONO <br /> Drilling Company: ( >� L�Q� <br /> Driller Onsite: C�� CcA� Screen Length From: To: <br /> Consultant: Pact.+ Filter Pack From: To: <br /> Geologist: TbW.1J Bentonite From: To: <br /> ,,,{{{ Grout From: To: <br /> Public Water System Onsite: Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes VINO carsa.ng <br /> If yes, location and distance: // � height <br /> SAMPLING ABOVEGROUND GiR151YBOX <br /> Holding Temperature: oowLEf1oN COMPtE ON <br /> Method: Ground Strlxa <br /> Screening Method: crow <br /> Verified Chain of Custody: ❑ Yes ONO ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑Yes ONO = •'. <br /> If yes,spoils storage Location: <br /> �sedon '� E <br /> Covered: ❑ Yes ONO _a <br /> _ gnvat pack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: IL <br /> Depth to Water: Z: AIb ft• — ft <br /> Grout Material: C <br /> Gallons of Grout Used: s �pD MATERIALS/DEVELOPMENT <br /> • Casing Type: <br /> ❑Well Installation OWell 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 Grout Over Drill Filter Pack Type/Size: <br /> ❑ Gravity /Tremie ❑Other: Type of Method: <br /> Water /Cement 471b Water Cement 941b <br /> Ilons BaRs eallons Bags <br /> Thickest Thinnest aBags Thickest Thinnest #Bags _Bentonite/Cement Mix 13%MIX 5%MIX <br /> 2.5 5 1 5 10 1 Bentonite per471b 1.411 2.47 <br /> 5 10 2 20 20 2 Bentonite per 941b 2.821 4.7 <br /> 7.5 15 a 15 30 B <br /> 10 20 4 28 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 so 8 <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.corn <br />