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c°z SANSJ0AQUIN <br /> a� Environmental Health Department <br /> --COUNTY-- <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: `GTO Inspector: CCarol Rr85TV CONSTRUCTION <br /> Facility Address: 1O0 i♦ runt af -mr3(rw, <br /> Well Address: Total Depth: <br /> WP# W41'2U2 Well#: Drilling Rig Type: <br /> Soil Boring#: Cr`I- I" , CPT- 34 , f;'`I <br /> Drilling Company: GQQ kX SyhSuftUCZ l;Xp1Ur.ifiy/; Min 2" Annular EHD Seal Verified: El Yes El No <br /> Screen Length From: To: <br /> Driller Onsite: 910n <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes E]No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes 11 No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GRCUNO <br /> Holding Temperature: COWLETION c�tFncii <br /> Method: G-Wnd Sudan <br /> Screening Method: B"4' ori <br /> n. <br /> Verified Chain of Custody: El Yes ❑ Qi 2Q fqe+ tnQ airNo (no)"Or %Nqn-t OR • n. <br /> SPOILS VT;Iling n' <br /> swppQd and tnQ =_ <br /> Contamination Noted: ❑ Yes ❑No halt rYQS 9►�nrt <br /> If yes, spoils storage Location: V(ltll G.Ulk(tZtQ slonad <br /> C+�iY1Q�t1T'. p IItt1J soon �� _ <br /> Covered: ❑ Yes ❑Nogra-4 Pack <br /> :: <br /> If yes, material: <br /> bICA ,A Q-fP)Qtt MXi <br /> R11 On Wwpt S,- <br /> GROUTING or DESTRUCTION Total Depth: 1 f MZ MrfI d 10. TCV fl= <br /> Depth to Water: 3C,' QF CuMVTt---n• n' <br /> Grout Material: t0Qt CQMQn1' t`CIS sa k r-Ica(( C1SP1'1Q1f• <br /> Gallons of Grout Used: 31 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Aoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ['Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest rt 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 /> 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 4Cpl-,315 CPT' 6 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 - .-S X 41 It,, Caun 5 y}ib CZi1nQ�t <br /> 17.5 35 7 35 70 7 14 qQ 110'r, 4't a t+ (- i'2 UII <br /> 20 40 8 40 80 a G1S WQ tOr <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 />