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S A N--%,J 0 A 0 U I N <br /> —COUNTY— Environmer Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:C6J?2',)` Inspector: gig iG7.y"iVLQ. CONSTRUCTION <br /> Facility Address: o A i,rpgy, <br /> Well Address: Total Depth: <br /> WP#(x1?,';� & Well#: Drilling Rig Type: <br /> Soil Boring#:S d '3 AC 5V-3 E�,b Sof 5 AC,� C'V i�5�Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: .('.F . <br /> Driller Onsite: �6 Screen Length From: To: <br /> Consultant: A'& E. Filter Pack From: To: <br /> Geologist: Tjvyl "( I&"- 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 <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING AEOQVE-4 FAOUND <br /> Holding Temperature: C0&FLE j0f4 <br /> COWLETjON <br /> Method: cra;nasutx.-� <br /> Screening Method: Drocrt <br /> Verified Chain of Custody: ❑ Yes ❑Noft- <br /> fi. <br /> ft <br /> SPOILS <br /> [, -:; <br /> Contamination Noted: ElYes ❑NoIf yes,spoils storage Location:Covered: ElYes []Nog-�PackIf yes, material: <br /> GROUTING or DESTRUCTION Total Depth:VV_ �jTo 6 , -LoDepth to Water: n ()Vft• <br /> Grout Material: V\444_ <br /> Gallons of Grout Used: I "I1 ai '/Z ?� l�o�d) MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well�Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation111-9 oring 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 ❑Tremie '[Other: Type of Method: <br /> 4Water Cement 471b Water Cement 941b <br /> ons Bags allons Bags <br /> Thinnest #Bags Thickest Thinnest #Bags BentonitefCement Mix 3% Mix °!° Mix 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 10 2 10 20 2 Bentonite per 941b 2.82 4.7 <br /> . 15 3 15 30 3 - i <br /> 10 20 4" 20 40 1 4 Had <br /> 12.5 25 5 25 50 5 't ad u c I I I e-x� sv I i bo <br /> C L �F 1 Vic <br /> 1. 30 6 30 70 . 7 � ��r)2 (,p 4C I d n O T � b <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 I T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />