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SAN 10AQUIN Environmental Health Department <br /> L_. COUNTY <br /> �gtr�oaP�/ Greatness grows here. <br /> 9 <br /> Monitoring <br /> �i'L �Well/Soil Boring Inspection Report <br /> Date:3,L& / Inspector: � T7?� <br /> iA CONSTRUCTION <br /> Facility Address: 2025) /v- S -T jo.-9 cit <br /> Well A d,�jess: Total Depth:�� S n i, d,� J � <br /> WP# �y 3 9,3c�1 Well#: Drilling Rig Type: /.� rq <br /> Soil Boring#: Z Min 2" Annular EHD Seal Verified: ❑ Yes 11 No <br /> Drilling Company: ie40 11;1K) NUJ <br /> Driller Onsite: / Screen Length From: To: <br /> Consultant: 7( i Filter Pack From: To: <br /> Geologist: (��(61ne <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑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: COWLEON �OMPLEnoN <br /> T{ <br /> Method: Ground Surfact <br /> Screening Method: grC&A <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> n. <br /> n. <br /> SPOILS a <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> stoned <br /> sacJon !K. — <br /> Covered: ❑ Yes ❑No = g,,;.1 p..k <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Dept * =_ <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:_zZli- 0OI1 <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity 19Tremie []Other: Type of Method: <br /> Water Ceme 471b Water Cement 941b <br /> allons Bas iRmlli ons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest 9Bags 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 /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 1 8 <br /> -Is <br /> v '" <br /> f 10/16/2017 <br /> 8 ��yP 1 EHazelton Avenue <br /> I 6tockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />