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5AN 10AQUIN <br /> __ COUNTY Environmental Health Department <br /> — <br /> ,• ��,T;.. � , <br /> GrFu'tness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:-` Inspector: CONSTRUCTION µtlJ Z <br /> Facility Address: to 2, Vit VI <br /> Well Address: Total Depth: 1"l+ VJ l 5i : 55,21 <br /> WP#. � 112 Well#: Drilling Rig Type: <br /> Soil Boring#: �)UL���U Min 2"Annular EHD Seal Verified: El Yes ❑No µ�f!s�v <br /> Drilling Company: � (yr) 1 P f1k ,) —"� <br /> Driller Onsite: K ); Screen Length From: To; <br /> Consultant: Filter Pack From: To:Geologist: 16 u Bentonite From: To: Mw 15_C <br /> Grout From: To: r C� <br /> Public Water System Onsite:\ El Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box �l l <br /> Domestic Well Onsite: ❑Yes ❑No casing ' <br /> If yes, location and distance: height <br /> SAMPLINGjygp <br /> Holding Temperature: 00?�OLETJON <br /> Method: <br /> Screening Method: aro�t <br /> Verified Chain of Custody: ❑ Yes ❑No 'l tr• <br /> ft. <br /> SPOILS ft• <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> atorwd 2 <br /> ss•Caon <br /> Covered: ❑Yes ❑No <br /> If yes, material: -" <br /> GROUTING-or-DESTRUCTION.Total Depth:-- ---- -- _ <br /> Depth to Water: 7 Li <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: bahCasing Type; <br /> ❑Well Installation t5Well Destruction N YJU Blank Feet Screen Feet <br /> YJ �5 Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity J Tremie Kother: ieX O�I� Type of Method: - -- <br /> Water cement 471b Water cem nt 941b <br /> alions Bags allons B <br /> Thickest Thinnest 4Bags Thickest Thinnest 4Bags SentonitelComent Mix 3% Mix 5% Mix <br /> 2,5 5 1 5 10 1 Bentonite per 47lb 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 9 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 3S 70 7 <br /> 20 40 8 AO 80 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.com <br />