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'�o Z\, SKJOAOUIN <br /> Environmental Health Department <br /> COUNTY— <br /> e," r G-eotness grows mere. <br /> (� Monitoring Well/Soil Boring Inspection Report <br /> Date: 1 Inspector: '���� CONSTRUCTION <br /> Facility Address: M& PQ <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: X�,,� QLa-,R! -( <br /> Soil Boring#: <br /> Drilling Company:6�kd)'Ah p�� Min 2"Annular EHD Seal Verified: Yes El <br /> Driller Onsite: �� $ <br /> �' �� 1 p4Screen Length From: To: <br /> Consultant: Filter Pack From:'L'15 To: 2� <br /> Geologist: Bentonite From: To: <br /> Grout From: 260 To: 4j <br /> Public Water System Onsite: El Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: Yes ❑No <br /> r� casing <br /> If yes, location and distance: �Q �?� . �b�.�.:�.� : � height <br /> M In %—Q)ke�) Q C S��NL <br /> SAMPLING wBovE-GrCUND <br /> Holding Temperature: 'CWP�ION TTloorxi <br /> Method: a-ound <br /> i <br /> Screening Method: rc(A <br /> Verified Chain of Custody: ❑ Yes El No <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: <br /> Covered: ❑ Yes ❑No = <br /> 4:r — gravel pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 2.1 <br /> �i� <br /> ep ater: <br /> Grout Material: kQ�JC�_ MATERIALS/DEVELOPM ENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> 'Well Installation ❑Well Destruction Blank __Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ItTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest VBags Bentonite/Cement Mix 3% Mix 3%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 /> i7.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />