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i <br /> SAN 1UAQUIN <br /> Environmental Health Department <br /> ( " ' �_■ ' �> m` ` I COUNTY <br /> Foa�'�P I Greatness grows here . <br /> Monitoring Well /Soil Boring Inspection Report <br /> Date : /6 ZZ Inspector : w4S� � CONSTRUCTION <br /> Facility Address : 0016 Heti) "7 �s N < 14osmm4y <br /> Well Address : Total Depth : <br /> WP # t �3 Well # : 024e .,; j'` Drilling Rig Type : <br /> Soil Boring# : Min 2 " Annular EHD Seal Verified . ❑ Yes ❑ No <br /> Drilling Company : <br /> Driller Onsite : Screen Length From : To . <br /> Consultant : et, Filter Pack From : To : <br /> Geologist : _��„ <br /> 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 /> SAMPLING JIgrJYE-GROUND <br /> C <br /> COMPL.ETiON HAiSTY-SOX <br /> Holding Temperature : cO*APt.FnoN <br /> Method : end Surface + <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes El No Amm mam, n- <br /> tt. <br /> SPOILS ft• aammommem <br /> — <br /> Contamination Noted : ❑ Yes ❑ No <br /> 0 <br /> If yes , spoils storage Location : slate <br /> aaczcn — <br /> Covered : ❑ Yes ❑ No <br /> If yes , material : _ <br /> GROUTING or DESTRUCTION Total Depth : ' _= <br /> :a- <br /> Depth to Water . 2� Z —Grout Materia I : &,a'ot' e''(U <br /> Gallons of Grout Used :. / Vin` elge f/ MATERIALS / DEVELOPMENT <br /> Casing Type . <br /> ❑ Well Installation IIVell Destruction Blank Feet Screen Feet <br /> ❑ Boring Installation ❑ Slot Size : <br /> Boring Destruction Bags Size : <br /> Cement : <br /> METHOD USED Bags Sand /Gravel . <br /> ❑ Pressure Grout ❑ Over Drill Type/ Brand of Bentonite : <br /> dTremie <br /> Filter Pack Type/Size : <br /> ElGravity ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest # Bags Thickest Thinnest # Bags Bentonite/Gement 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 I Stockton , California 95205 1 T 209 468 - 3420 1 F 209 464 - 0138 1 www . sicehd . co_m <br />