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SAN_ 1OQQUIN Environmental Health Department <br /> -----COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> ro� 2 <br /> Date: I Inec r: 1 �/I'' �r�/ CONSTRUCTION Ft�,w � > If, <br /> Facility Address: 7S e rrr; <br /> s <br /> Well Address: Total Depth: <br /> WP# Is Well#: Drilling Rig Type: <br /> Soil Boring#: 2F-IS - 00j, -2 - -(00 <br /> Drilling Company: GeV -E <br /> Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Driller Onsite: c V E Y" Screen Length From: To: <br /> Consultant: A SCO Filter Pack From: To: <br /> Geologist: - ✓ ,' 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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONF�TION �EMN <br /> Method: Ground Surface* <br /> Screening Method: gra.rt <br /> Verified Chain of Custody: ❑ Yes El No �--n- <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> _ o <br /> If yes, spoils storage Location: <br /> allotted <br /> aKJon = 3 <br /> Covered: ❑ Yes El No _ 9-vol pack <br /> If yes, material: // <br /> GROUTING or DESTRUCTION Total Depth:65 -F4 Pf <br /> Depth to Water: 0 -r tL —GroutMaterial: AIPA4 <br /> Gallons of Grout Used: 5 6 )0,1 + 'ihal MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation *oring Destruction <br /> Bags of Cement: <br /> METHOD USED �O�v �cr:�'Z�' g 3S 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 94 lb <br /> gaa Ilons Bas gallons Bags <br /> Thickest Thinnest RBags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5%MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 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 /> 35 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 8o 8 <br /> 40 y't.A ay 10/16/2017 <br /> Qq g a l tom. b S <br /> 1868 E. Hazelton Avenue !Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />