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SANsJ0A0UIN <br /> COUNTY— <br /> Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 0 inspector: Off CONSTRUCTION <br /> Facility Ad dress; 330 a <br /> Well A dress: Total Depth: <br /> WP# Well Drilling RigType� <br /> Soil Boring#: 4, 1Z Drilling Company: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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 <br /> aas ing ' <br /> If yes,location and distance: height <br /> WT <br /> SAMPLING ABOW-GIFIC)UND cii iisr Box <br /> Holding Temperature: OOMPLEION couplEnoN <br /> Method: cYotnasurrwc.-�, <br /> Screening Method: yr(a t <br /> Verified Chain of Custody: ❑Yes El No -_--—ft <br /> SPOILS c <br /> Contamination Noted: ❑Yes ❑No 9fi <br /> If yes,spoils storage Location: _ s <br /> II10t14f1 N .r <br /> Covered: ❑Yes ❑No tx5on c <br /> If yes,material: — <br /> GROUTING-or-DESTRUCTION.Total Depth:_�� . <br /> Depth to Water: / ft ft - <br /> GroutMaterial:Gallons of Grout Use , C MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation ring Destruction gags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> El Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 9414 <br /> Aall s Bags allans Ba <br /> T Ickest Thinnest 7t Bags Thickest Thinnest 08ags 80ntonite—ament Mix -3% Mix 5% Mix <br /> 5 1 s 10 1 8entonite per 47 JIB1.41 2 47 <br /> s 16 2 l0 20 a Bentonite per 94 lb 2.82 4.7 <br /> .5 15 3 15 80 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> Is 30 6 80 s0 6 <br /> 17.5 85 7 95 70 7 <br /> 20 40 8 40 80 8 ' <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />