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o;'v <br /> A_..� . SAN :IOAQUIP <br /> 2 ` <br /> COUNTY— <br /> Environme 1 Health Department <br /> il` Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1 Inspector: CONSTRUCTION <br /> Facility A dres : <br /> Well Address: � _�, ,y�� M Total Depth: <br /> WP#/J P,90 ��1 ��7 57 OWell#: I Drilling Rig Type: <br /> Soil Boring#: �- f <br /> Drilling Company: f� Min 2"Annular EHD Seal Verified: El Yes 11 No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: L 9M tl 4A� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> W– T —ev, <br /> SAMPLING A 1OVE-GROUND <br /> Holding Temperature: COAFLETION GCOMP�LETION <br /> Method: c3=ndsumacs + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> tt. <br /> SPOILS - '- <br /> Contamination Noted: ❑ Yes 91V0 r <br /> If yes,spoils storage Location: <br /> slotted <br /> Bacton = <br /> Covered: ❑ Yes ❑No <br /> If yes, material: ; <br /> GROUTING or DESTRUCTION Total Depth: . <br /> IF <br /> Depth to Water: C7 ft. — tt- <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation e: <br /> oring Destruction Bags Slot Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> L;�tiravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 941b <br /> allons Bas allons Bags <br /> Thickest Thinnest tJBags 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 /> s 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 8 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 />