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SAN 10AQUIN <br />Environmental Health Department <br />COUNTY <br />o9k,P� Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ro A10 / Inspector: G` CONSTRUCTION <br />Facility Address. 00 " <br />Well Addres : Total Depth: <br />WP# Z� L Well#: / Drilling Rig Type: <br />Soil Boring#: (D l Z 2 Z �Z <br />Drilling Company: yKP2 6 Min 2" Annular EHD Seal Verified: El Yes ❑No <br />Driller Onsite: V Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: �L' Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes EI No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />❑ Yes El No <br />Verified Chain of Custody: ❑ Yes <br />SPOILS <br />Contamination Noted: ❑ Yes <br />If yes, spoils storage Location: <br />Covered: ❑ Yes <br />If yes, material: <br />casing <br />height <br />7 W- -Crw-f <br />ABOVE -GROUND CHRIM41BOX <br />CONFLETION COMPLETION <br />Ground skrfwe <br />I <br />t3 I 1 C grout <br />n. <br />❑ No z; I L ft. <br />ONO <br />C <br />alottsd J 3 <br />❑ No = pawl pack <br />GROUTING or DESTRUCTION Total Depth: 100 T -1 <br />Depth to Water: '� �%' G n tt. <br />Grout Material: D,0 - <br />Gallons of Grout Used: Z.o <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation EgBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />l9.Gravity ❑Tremie ❑Other: <br />111� <br />Water <br />allonz <br />Ceme 471" <br />6 <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />"Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 is <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: _ <br />Filter Pack Type/Size: <br />Type of Method: <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />I. Z o � '� 1 � 10/16/2017 <br />x- <br />1868 E. Hazelton Avenue I Stoc ton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />