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SAN-d.J0A0UIN <br /> Environmental Health Department <br /> —COUNTY— <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Win Ins Inspector: L-'..i i. CONSTRUCTION J <br /> Facility Address: 25"1'15 S 0.t4r.4o o <br /> Well Address: Total Depth: <br /> WP# QOU411 Well#: Drilling Rig Type: H61(_ nom, C� <br /> Soil Boring#: BVD Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: S Filter Pack From: To: <br /> (}rt�e.�J <br /> Geologist: 8&k%, Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No csing <br /> If yes, location and distance: naight <br /> SAMPLING ABCV-=-GRCXJND <br /> COWFLETION CHRISfY-BOX <br /> Holding Temperature: CLhWLETiON <br /> Method: G=r)d S"rtx' <br /> Screening Method: gfout <br /> Verified Chain of Custody: ❑ Yes ❑No fL <br /> ft_ <br /> fi. <br /> SPOILS = <br /> Contamination Noted: ElYes ❑No - — <br /> If yes, spoils storage Location: shr� <br /> Covered: ❑Yes ❑No _ <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: �:j c =_ <br /> Depth to Water: a - — ' <br /> Grout Material: P\,ra;f C1 <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation �� Bag <br /> ❑W��ell Destruction Blank Feet Screen Feet <br /> Slot El Boring Installation 1?5oring Destruction 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 LW'Femie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas vallons Bags <br /> Thickest Thinnest #Bags 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 20 404 <br /> 12.5 25 5 25 50 5 t' <br /> 17.5 35 7 35 70 7 / y,05 sb� S <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />