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° z� SANA0AQUIN_ Environmental Health Department <br /> ("AID #, —COUNTY— p <br /> -°y =�`•�r. Greo'tnass grows here. <br /> yrFirc i <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: 1 A&S CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP#0f$ 4494 a % Well#: Drilling Rig Type: <br /> Soil Boring— #Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: i? Screen Length From: To: <br /> Consultant: A1rf" �j Filter Pack From: To: <br /> Geologist: CDrn hof 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 Casing ' <br /> If yes,location and distance: W height ' <br /> SAMPLING Agpy€,6ROUND oH» box <br /> Holding Temperature: CO �i1ON co�w> rioN <br /> Method: vc«3ms�rx.- -�-� <br /> Screening Method: arjo, t <br /> Verified Chain of Custody: ❑Yes C]No �--n• <br /> SPOILS ___.tt• <br /> 8. <br /> Contamination Noted: ❑Yes ❑NoEE <br /> if yes,spoils storage Location: $ <br /> Y ' P g abtwd Ei B <br /> Covered: ❑Yes ❑No saslon s <br /> If yes,material: <br /> GROUTING-or-DESTRUCTION•Total Depth:--��.•-. ,•, <br /> Depth to Water: n• <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction '3DjI vqft)r Blank Feet Screen Feet <br /> ❑Baring Installation ❑Boring Destruction �r�c Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout []Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Slze: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water ment 4716 Water Cement 941b - <br /> allons Ba s eallons Bags - <br /> Thickest Thinnest ags Thickest I Thinnest NBags EEB)onforilte <br /> tanite/Gement Mix $%Mix 5%MIX <br /> 2.s 5 1 s 10 1 per47lb5 10 2 10 20 2 onito per 94Ib 2,82 4.7 <br /> 7.5 1s s 1s so B i , <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 1s so 6 so so 6 <br /> 17.5 as 7 as 70 7 <br /> ZO 40 8 AO 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138.1 WWw.sicehd.com <br />