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S A N D OAQ U I N Environmental Health Department <br /> —COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: ak W-VC.-S CONSTRUCTION <br /> Facility Address: Hu q+Er St. <br /> Well Address: Total Depth: <br /> WP# 06 4 4 U$7 Well#: u�A�J Drilling Rig Type: <br /> Soil Boring#: Cp1 2�, a—A 10 —��(�,'113 Min 2 Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: Nli dd(e r-N�64 �" <br /> Screen Length From: To: <br /> Driller Onsite: yA'h <br /> Consultant: vwi f- Filter Pack From: To: <br /> Geologist: r ?t I I•v 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: height <br /> SAMPLING AWVE-.GROUND <br /> Holding Temperature: COh3F'LETION cMrtPiETioN <br /> Method: around Swiacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> _ <br /> SPOILS " <br /> Contamination Noted: El Yes ❑No <br /> If yes,spoils storage Location: <br /> abttcd M = <br /> tettion <br /> Covered: ❑ Yes ❑No ;k = <br /> 0 1w pad* <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> a- <br /> Depth to Water: k7 n• " "`Grout Material: un!� l-K MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type; <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation PgBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity 6ITremie ❑Other: Type of Method: <br /> Water Cem 4711a Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest , ags Thickest Thinnest It Bags BentonitelCeinent Mix 3% Mix 5% Mix <br /> 2.5 5 1 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 1 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 1 8 40 1 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />