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f �, SANAOAQUIN <br /> I1.rTQ `—coulvrv— Environmental Health Department <br /> t� Greatness grows here. <br /> r;tghk Monitoring Well/Soil Boring Inspection Report <br /> Date: — II 5 ins pector:y�-SQ, CONSTRUCTION <br /> Facility Address: Fit c- flue - <br /> Well Address: ,E9il*7- Total Depth: <br /> WP# DO L1L Cto� Well#: Drilling Rig Type: <br /> Soil Boring#: RW 00( !k i 2la4 b-)-P f <br /> Drilling Company: P-e-ir% t nr`2 Min Z"Annular EHD Seal Verified: ❑Yes ❑No <br /> r <br /> Driller Onsite: t` tCOA Screen Length From: To: <br /> Consultant:_ (77 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 casing <br /> If yes,location and distance: height ' <br /> SAMPLING aeov> �aaoulao <br /> coNa ctt�lsrrsox <br /> Holding Temperature: <br /> LErx7N CWPI.ErioN <br /> Method: swtaco -- =- <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑No iR <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No s ' <br /> If yes,spoils storage Location: `= s <br /> ab,yy+5"5 sic w Ei <br /> Covered: ❑Yes ❑ q5 fi3 - on <br /> If yes,material: <br /> GROUTING.or-DESTRUCTION.Total Depth:-`J- •�ZrJ t <br /> 1.. 8� lQ'i . . <br /> Depth to Water: �35t ft T ft' <br /> Grout Material: N PLI-�- CX�'LW,VL�- S'�`� <br /> 1MA7 RfALS/DEVELOPMENT <br /> Gallons of Grout Used: ^"R(xltfr' ��'YII�/'.Gs. � I ZS <br /> Casing Type: <br /> ❑Well Installation OWWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation QB Slot Size:oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout AOver Drill 6X&Stv45 Filter Pack Type/Size: <br /> ❑ Gravity Mremie ❑Other: Type of Method: <br /> Water ment 471b Water cament941h <br /> Ilons BaRs gallons Se <br /> Thickest Thinnest TWest Thtonest "ags Bontonite/Cement Mix 3%Mix 5% J.47 <br /> 2.5 5 1 s 10 1 Bentonite per47lb 1.41 25 10 a 10 20 z Bentonite per 941b 2.82 <br /> 7,5 15 a is Be a <br /> 10 "408 <br /> 20 40 4 <br /> 12.5 25 so 5 <br /> is 30 60 6 <br /> 17.5 35 70 7 <br /> 20 40 80 e ' 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 96205 1 T 209 468-34201 F 209 464-0138 1 www.sicohd.com <br />