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SAN.:IOAQUIN Environmei.,al Health Department <br /> —COUNTY—reone 9 <br /> Gtss rows hu <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: iuI112 2010 Inspector: Gly CONSTRUCTION <br /> 04 Facility Address:1I Efl� Al(1YU ` <br /> Well Address: E W MA Total Depth: <br /> Vyp# Well#: lt6 '_ Drilling Rig Type: <br /> Soil Boring#: Min r Annular EHD Seal Verified: ❑Yes ONO <br /> Drilling Company: A Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: Bentonite From: To: <br /> Geologist: Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND chffiisry-sox. <br /> Holding Temperature: OOMPLErION COMPLETION <br /> Ground Sala <br /> Method: grout <br /> Screening Method: o <br /> ft. <br /> Verified Chain of Custody: ❑ Yes ❑No tt, <br /> SPOILS <br /> Contamination Noted: ❑Yes ONO — <br /> If yes,spoils storage Location: <br /> awtdo c 3 <br /> •KSn 4i c <br /> Covered: ❑Yes ❑No ^ _ pnvat pant <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:3�S .q _ ' tt <br /> Depth to Water: <br /> Grout Material: '� C QO MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Qvinwris AUK �1n e YOIA sing Type: <br /> e: <br /> ❑ y IY <br /> Well Installation ()tWell Destruction VW\� 4 Blank Feet Screen Feet <br /> Slot Size: <br /> []Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED E�tpMw't Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Clover Drill Filter Pack Type/Size: <br /> faGravity ❑Tremie ❑Other: <br /> Type of Method: <br /> Water Cement 4711a Water Cement 991d <br /> R75 <br /> ns Bagsallons Bags <br /> Thinnest #Bags Thickest Thinnest aaggs Bentonite/Cennent Mix 3% MIX 5%Mix <br /> s 1 5 10 1 Bentonite per 47lb 1.41 2.47 <br /> So 2 l0 20 2 Bentonite per 94Ib 2.82 4.7 <br /> 15 1520 4 20 40 4 <br /> 25 5 25 50 530 6 3o 60 6 <br /> 35 7 35 70 7 <br /> 20 1 40 1 0 1 40 00 3 <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 />