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SAN ��QQ��N Environmental Health Department <br /> iiiQ `' COUNTY--- <br /> cy�ir Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: SuKh r e pt CONSTRUCTION <br /> i <br /> Facility Add re s: `j,�;0 RA I�rICjQe{1I-r1, 6 J� <br /> Well Address: Total Depth: <br /> WP# 00go I1 p� Well#: Drilling Rig Type: <br /> Soil Boring#: 97— IR <br /> Min 2"Annular EHD Seal Verified: ❑ Yes 11 No <br /> Drilling Company: V r 1n/ <br /> Driller Onsite: 8=6, Screen Length From: To: <br /> Kie .i 'X <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: I� <br /> ! TYII( Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑NoWT <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION COMPLEnoN <br /> Method: Ground Surfac+ <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No eft' <br /> ft. <br /> SPOILS . <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: <br /> slatted K! _ <br /> section '— <br /> Covered: ❑ Yes El No = gr,,,s,P-X <br /> If yes, material: : <br /> GROUTING or DESTRUCTION Total Depth:_ _ <br /> Depth to Water: • ft. <br /> Grout Material: Neat Ce meii <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation VBoring Destruction 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/Size: <br /> 13 Gravity ❑Tremie ❑Other: Type of Method: <br /> Water ment 4711 Water Cement 941b <br /> allons Bas Rall ons Bags <br /> Thickest Thinnest 4:Bags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 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 so 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />