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SA N 1 UAQ S I N Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: !;�j -66 spector: CONSTRUCTION <br /> Facility Address: 602, L W yjN7`Cq x ` v _ <br /> Well Address: 'N"otal Depth: <br /> WP# kc)1 \o-S Well#: � M��� Drilling Rig Type: <br /> Soil Boring#: \,vv.,) �1-�0-00 <br /> Drilling Company: F Q��j Min 2" Annular EHD Seal Verified: El Yes []No <br /> Driller Onsite: � ,��. �, Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant:Ted' <br /> Geologist:��� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT height <br /> SAMPLING ABOVE-GRCUND <br /> Holding Temperature: oo&PL.Erl0N COMPLETION <br /> Method: G=nd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �--n• <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: El Yes []No = <br /> If yes, spoils storage Location: <br /> slotted <br /> sac.cn <br /> Covered: ❑ Yes ❑No = i <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total DepthAo5 Ov5 % . <br /> Depth to Water: n• 2F tZ <br /> — tt <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: w) <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Borin Installation Slot Size: <br /> g Boring 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 L1Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bags gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5% Mix <br /> 2.5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 10 20 2 Bentonite per 94 lb 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 so a <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.cnm <br />