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i SWdOAQUIN Environmental Health Department <br /> -- C O U N T Y-- <br /> "`cciT✓. Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: s�'s%/9 Inspector: rtEA-- CONSTRUCTION GG"'"� f! Z L6„��s1`/�a�� <br /> Facility Address:?jP� 1}�, 4-/sk *4-s(!!! 4 ,,L <br /> Well Address: Total Depth: <br /> WP# ,03 S'ffY Well#: Drilling Rig Type: <br /> Soil Boring#: (-G60— t Y w 6e".) it <br /> Drilling Company: ��r,LLasi�i Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: �L 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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION c�tEnCN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —ft. <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> �• C <br /> If yes, spoils storage Location: slotted w ,_ <br /> aacdon Y' — B <br /> Covered: ❑ Yes ❑No = � <br /> If yes, material: — <br /> x <br /> GROUTING or DESTRUCTION Total Depth: Yoe, . =_ <br /> Depth to Water: q n — IF tt' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation NBoring Destruction Slot Size: <br /> 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 JOTremie ❑Other: Type of Method: <br /> ater Ce 471b Water Cement 941b <br /> allons Bags allons Bags <br /> Thic Thinnest 'x age Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 10 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 8 40 80 8 <br /> rL D S 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 />