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5AN )UAQUIN Environmental Health Department <br /> COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: Aor64y1_ CONSTRUCTION <br /> Facility Address: /ZU c�S d !2c , a <br /> Well Address: Total Depth: <br /> WP# aV Q 3 7 Yf Well#: Drilling Rig Type: <br /> Soil Boring#:_ _/�-/8' <br /> Drilling Company: cl9'K- Min 2" Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: �►-. Filter Pack From: To: <br /> Geologist: "e"-*j Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: 37 <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: Gfwnd SL;rtx' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> SPOILS =_ <br /> = m <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: <br /> slotted = d <br /> sac�on <br /> Covered: ❑ Yes []No <br /> P ,A Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: I <br /> Ll <br /> Depth to Water: -A [tJ t n• 2 — tt <br /> Grout Material: N lcw.0 <br /> Gallons of Grout Used: S�bk/lv�-o MATERIALS/DEVELOPMENT <br /> � //'� Casing Type: <br /> []Well Installation QWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout^�❑Over Drill Filter Pack Type/Size: <br /> El Gravity L�Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> gallons Bags pallons Bags <br /> Thickest Thinnest kBags Thickest Thinnest Bags BentonitelCement 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 1 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.com <br />