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SANIOAQUIN Environme I Health Department <br /> —COUNTY— <br /> of <br /> Greatness grows here. <br /> MonitoringgW- ell/Soil Boring Inspection Report <br /> Date: �- �� Inspector: ads)�, D CONSTRUCTION <br /> Facility Address: <br /> Well Address: ylJ.`cl� �oaos4/� Total Depth: a.� <br /> WP# �T Well#: (wJ- -lD Drilling Rig Type: V\SN, \'0�� <br /> Soil Boring#: p3 / P- Min 2"Annular EHD Seal Verified: Yes ❑No <br /> Drilling Company:_moo _�_� <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: ��_,..�rw�-�. "��`�-s, Filter Pack From: To: ol5 <br /> Geologist: ���c.v—� N�� `,��Q Bentonite From: �o To: `l3 <br /> Grout From: 4)v,,Lk. To: <br /> Public Water System Onsite: Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> 'B�¢Well Onsite: Yes ❑No casing <br /> If yes, location and distance:���� height <br /> SAMPLING y�5 AgpygGgpD <br /> Holding Temperature: COMPLETION COMPt�cN <br /> Method: G=ndSudit''�— <br /> Screening Method: grocit <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> _Lft. ft <br /> SPOILS <br /> Contamination Noted: ❑ Yes No x <br /> If yes, spoils storage Location: ,��, stoned <br /> section a <br /> Covered: ❑ Yes C/N0 <br /> — g 1 pack <br /> If yes, material: s«. <br /> GROUTING orrBf-STRUCYTf5N Total Depth: `per l __ <br /> Depth to Water: 'may �eb Mff <br /> ft' <br /> Grout Material: N MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: Vy <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: 0•O 1-0 <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: 2- L <br /> ❑ Gravity I\Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> gallons Bags gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 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 a <br /> 12.5 25 5 25 50 5 � <br /> 15 --6— 30 60 6 p Z <br /> 17.5 5 7 35 70 7 <br /> 20 40 80 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 />