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SAN 10AQUIN Environmental Health Department <br /> —COUNTY— <br /> Environmental p <br /> Grc:utr,c:i finr�c i,e:n'. <br /> Monitoring Well/Soil Boring Insloectio2n Ret <br /> Date: Inspector: CONSTRUCTION HLo ���/_ <br /> Facility Address:2�yo • IU 204 G�A`'/e <br /> Well Address: 21 ��� �' <br /> Total Depth: Nly <br /> WP# �Ul1�L��(1 Well#- 1 <br /> Soil Boring#: in5 �) <br /> J� Drilling Rig Type: <br /> Drilling Company: /1 be �iVI�JiI[1v1 i1�Win Min 2"Annular EHD Seal Verified: ❑No <br /> Driller Onsite: Screen Length From: _L_Z To: <br /> Consultant: A 6 R:11)4A� ���t� ter Pack From: To:�' <br /> Geologist:_ -0enUV-4 Behtonite From: To: <br /> Grout From: <br /> To: <br /> Public Water System Onsite: El Yes ❑No COMPLETION ❑ Stove Pipe Xhristie Box <br /> Domestic Well Onsite: ❑ Yes ❑No <br /> casing <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COIueiETbN c��oN <br /> Method: Ground Surface <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑Yes ❑Noft• <br /> ft. <br /> SPOILS <br /> k <br /> Contamination Noted: ❑Yes El No r` <br /> If yes,spoils storage Location: ._ <br /> 0 <br /> ataturd _ � <br /> sacdon <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br />-�AOVGROUTING o ESTRUCTION Total Depth: '2q �2A 2-= <br /> Depth to Water: tt• — n <br /> joxcout Material:�.C�GP_av-?—n <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: - l,t J/t <br /> � -�� " �f�-� Casing Type: (',her i I.-A-01kxX , S C ' W <br /> ❑Well Installation Well Destruction (ye5+V�1 ' Blank Feet cree� Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: y�o�7�- <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: ��; ��� <br /> Filter Pack Type/Size: SCu <br /> ❑ Gravity ATremie ❑Other: Type of Method: <br /> water ement 471b Water Cement 941b <br /> allons Bas allons I Bags <br /> Thickest Thinnest #Ba Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 5%Mix <br /> 2.5 s 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 z 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 1 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 1 B 40 80 B <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 />