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SAN_10AQUIN <br /> N Environmental Health Department <br /> r'r —COUNTY— <br /> Greatness grows her, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 11 LU Inspector: `'' CONSTRUCTION <br /> FacilityAddress: '� - OY� \X <br /> Well Address: Total Depth: <br /> WP# 00 4�tA -A Well#: Drilling Rig Type: <br /> Soil Boring#: St • Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: ti id ;r1c <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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 casing <br /> If yes, location and distance: height <br /> iii <br /> SAMPLING Agpyg..GRpuND <br /> Holding Temperature: COMPLETION C _o&iPLEnoN <br /> Method: GroundSufwa T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �tt' <br /> ft. <br /> it. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: slonad _ e <br /> saction <br /> Covered: ❑ Yes El No = 9-94 <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION T t I Depth: ICFj,0 __ <br /> Depth to Water: n tt' <br /> Grout Material: l'1k� N • MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 2- oakn5 Casing Type: <br /> ❑Well Installation ❑Well Destruction 0.,ojer. Blank Feet Screen Feet <br /> El Boring Installation gaoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> )9-Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest uBags 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 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />