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/" <br /> / c SAKJOAQUI1 Environmental Health Department <br /> Lsll� ��_�� —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 28 � Inspector: 1 hJ�- -t CONSTRUCTION <br /> Facility Address: 2.'ALI 9 i_6O/v2Y 1 G p 1 66 11 H S-A- <br /> Well Address: Total Depth:S 0 <br /> WP# Well#: Drilling Rig Type:Soil Boring#: MIA4 Min 2"Annular EHD Seal Verified: IX <br /> Yes []No <br /> Drilling Company: YT i i <br /> Driller Onsite: Screen Length From: 80 w To: 68 <br /> Consultant: Env iro hvwM� Filter Pack From: goy To: 50 <br /> Geologist: C�(IrnP', <br /> Bentonite From: To: b <br /> Grout From: To: Srrt,r Coro, <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION 'W Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: � height <br /> SAMPLING ABOVE-GROUND CHM �x <br /> O <br /> Holding Temperature: COWLErN COMPLETION <br /> Method: ci wnd sa fao.7— <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> b tt. <br /> SPOILS <br /> Contamination Noted: ❑Yes ONO 4� <br /> 6or <br /> If yes,spoils storage Location: ,lotto <br /> section sH = B gprylL�, <br /> Covered: ❑ Yes ONO — Or,,,,1P":x <br /> If yes material: =_ <br /> GROUTING DESTRUCTION Total Depth: 55/ <br /> Dept to Water: <br /> Grout Material: NeAf Q r qLq f MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: � SCh40 <br /> .Well Installation ❑Well Destruction Blank U) Feet Screen 2D Feet <br /> Slot Size: 0, <br /> h 2- <br /> 0 Installation El Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill Filter Pack Type/S,i�ee: <br /> ❑ Gravity gTremie ❑Other: Type of Method: IM 1P7 <br /> Water ment 471b Water Cement 941b <br /> allons Baas gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest 9Bags BentonitefCement Mix 3% Mix 5a/a Mix <br /> z.s s 1 s 10 1 In. er47lb 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94lb 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 /> 10 40 B 40 BO 0 <br /> 201rvp W/ —6Sp,QQsne jAvdov 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 />