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fez. SANJ0A0UIN Environmental Health Department <br /> L--�k6�F —COUNTY <br /> 59, P' Greatness grows her, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Q Inspector: CONSTRUCTION <br /> Facility Address: 10 — 97/) "10 <br /> Well Address: eftf. 34 Ked Total Depth: <br /> WP# $ 525 Well#: Drilling Rig Type: <br /> Soil Boring#: 610 , fi 11 Min 2"Annular EHD Seal Verified: ❑ Yes 11 No <br /> Drilling Company: terra CCC`\ <br /> Ne1Ac(' 1 f C� Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: 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 /> iii T <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLEMN �tPLE toN <br /> Method: G=na Surface <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes ❑No �ft' <br /> it. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: slo�d <br /> aoc2cn — B <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 0 4 =_ <br /> Depth to Water: tL n' <br /> Grout Material: �1Ca, •� 4+ <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation�Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> l Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest &Bags 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 A I <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> ID }t 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 />