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SANAOAQUIN Environmeia al Health Department <br /> �. � —COUNTY— <br /> "F� Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:-I'/7-/y Inspector: N9S6* - CONSTRUCTION <br /> Facility Address: Z40 S^6�14W '4' Total Depth: <br /> Well Address: <br /> WP4t.2214$� WellM , O-// Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: Casc r /Ji'tl'a� Screen Length From: To <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: /tt%�f5 "� Bentonite From: To: <br /> Geologist: 7,rv- — Grout From: To: <br /> Public Water System Onsite: ❑Yes No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No —z— casing <br /> -- �� height . <br /> If yes,location and distance: <br /> SAMPLING ASCIM-GROUND ahwlM4= <br /> COMPLETION COMPLETION <br /> Holding Temperature: Grounds ace --r--- —'— <br /> Method: grout <br /> Screening Method: <br /> Verified Chain of Custody: ❑ Yes ❑No n• <br /> SPOILS o <br /> Contamination Noted: <br /> ❑Yes ❑No — <br /> er xri�iJ/ic '� = '- s <br /> If yes, spoils storage Location: 5 7✓Q�,;jw SIG ttad '! = 8 <br /> cJ. s*clon . 1 <br /> Covered: ❑Yes El No r Zt4 r = gm%*p=k <br /> if yes, material: ys <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: nr6& <br /> Grout Material: 1/ �pnv .l MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: -iL Casing Type: <br /> [?Weil Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie 90ther: 1�"61) <br /> Type of Method: <br /> Water Cement 411b Water Cement 941b <br /> allons Ba s allons Ba s <br /> Thickest Thinnest Hags BentonitelCement Mix 3%Mix 5%Mix <br /> 2.5 Th Thinnest gaggs Bentonite per 471b 1.41 2.47 <br /> .5 5 1 5 10 1 - 2.82 4.7 <br /> 5 30 2 10 20 2 Bentonite per 941b <br /> 7.5 15 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 5 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 4o a 40 80 B 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www sicehd.com <br />