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SAN 10AQUIN Environmental Health Department <br /> -COUrJTY. <br /> J Monitoring Well/Soil Boring Inspection Report <br /> Date: ]/y I Inspector: ^rEs " CONSTRUCTION <br /> Facility Address: L,rfe <br /> Well Address: Total Depth: <br /> WP# ew .30efl Well#: Drilling Rig Type: <br /> Soil Boring#: r3/,z, <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: J`7`d•N Screen Length From: To: <br /> Consultant: i,,(!4//cciF-- KkJ Filter Pack From: To: <br /> Consultant: <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 ❑No casing <br /> If yes,location and distance: 1?a height <br /> 7 Iffl— —CrWT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONPLErION COMPLETION <br /> Method: Ground Surf"' T <br /> Screening Method: QfO1t <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: afonoe <br /> tsc:cn <br /> Covered: ❑ Yes El No t4 = a=ri+aa-K <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ft ft' <br /> Grout Material: (� CC'w►ClL <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation RBoring Destruction 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 ❑Tremie AOther+'"/t Type of Method: <br /> ate` (Ilemleril 4 Water Cement 1411 <br /> alto eallons Baits <br /> Thi st Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per47 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 /> IS 30 6 30 1 60 6 <br /> 17.5 35 7 35 1 70 1 7 <br /> 20 40 8 40 80 8 <br /> 1 !;7 10/16/2017 <br /> SD <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />