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=OP° ct� SA6JOAQUIN <br /> Environmental Health Department <br /> _ <br /> I COUNTY <br /> Greatness grows here <br /> Monitoring }W- ell/Soil Boring Inspection Report <br /> Date: 5 I 0 Q Inspector: s� �� -'l CONSTRUCTION <br /> Facility Address: rr <br /> CAI �1�cv,v> ��v �•-S <br /> Well Address: Total Depth: <br /> WP# C)() 'A-6-5- Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: c-, <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING Asove•cROUNO _ <br /> Holding Temperature: COMPLETION con+�t_EncrXi <br /> Method: around Suri"' "'+ <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> SPOILS ft. <br /> tt. <br /> SPOILS = <br /> K. — <br /> v�= e <br /> Contamination Noted: ❑ Yes E]No <br /> C <br /> If yes, spoils storage Location: sbd <br /> on <br /> Covered: ❑ Yes El No = tx-vl+Pack <br /> If yes, material: _= <br /> GROUTING or DESTRUCTION Total Depth: 3� <br /> Depth to Water: n• tt' <br /> Grout Material: NALa P MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation NBoring 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 *remie []Other: Type of Method: <br /> Waterent 471b Water Cement 941b <br /> Ce <br /> allons Bas gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest 9Bags 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 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 /> 20 40 40 80 8 <br /> 5 0 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />