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SANoJOAQUIN <br /> `t Environmental Health Department-COUNTY-Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 10917,4 Inspector: L CONSTRUCTION <br /> Facility Address:OgA1;t ( '11,610W l-44Y." <br /> Well Address: Total Depth: <br /> WP#Wg53a8 Well#: Drilling Rig Type: <br /> Soil Boring#: VOLW 5*6 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: to <br /> Driller Onsite: ,? H <br /> Screen Length From: To: <br /> Consultant: tS tt t`v1 k e(a(e e- Filter Pack From: To: <br /> Geologist: M!K n C.v1 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes LINo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No -� casing <br /> If yes, location and distance: j+__E( height <br /> _EWT <br /> SAMPLING ABOVE-GROUND <br /> Co&FLETION COMPLE-BOXn4a� <br /> Holding Temperature: conoN <br /> Method: Giround s,1a4.r <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No n <br /> —n. <br /> n. <br /> SPOILS = <br /> u a . <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: 4wnod ` <br /> wrlon 'ci = 8 <br /> Covered: ❑Yes ❑No — g-val <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:XL6 tr, <br /> Depth to Water: rj.Nl - SC• I I tt. = tt. <br /> Grout Material: yleq�- [~Meth) <br /> Gallons of Grout Used: 8 5 o c#1 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation 1�Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation 1❑B_oring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity YkTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags allons Bags _ <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags _ Bentonite/Cement Mix 3%Mix 5%Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 Bentonite per 94 lb <br /> 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 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 t,,� 8 40 #0 # <br /> IZ aq1.S _' c4s«1 10/16/2017 <br /> 1868 E. Hazelton Avenue i Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />