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f SQNJDQQUIN Environmental Health Department <br /> COUNTY <br /> Greotness gratis here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 3/10 Inspector: JL1 S�Lj��(� CONSTRUCTION <br /> Facility Address: qy1L S• ►� 99� Sa�C �vn <br /> Well Address: Total Depth: <br /> WP# , ' Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ElYes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: cow(or ZGwt�_ Filter Pack From: To: <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: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CoWs.EtI°N CCW�o_N <br /> Method: G=nd Swfaca <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft- <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: x10 y <br /> sacn = 3 <br /> Covered: ❑ Yes El No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 1IF/ <br /> Depth to Water: '— - <br /> Grout Material: ,N CP!"' <br /> Gallons of Grout Used: '— MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation,KBoring 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 /> �<rravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water :!em�entMvallons Bas allons Thickest Thinnest 4Bags Thickest Thinnest gBentonitefCetnent Nix 3% Mix 5% t ix <br /> ----------------- <br /> 2.5 11 s 10 1 Bentonite per 47 Ib 1.4'1 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 1 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 I www.sicehd.com <br />