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SANsd0AQUIN,i. Environmental Health Department <br /> i —COUNTY— <br /> , <br /> Greatness grows here, <br /> :c <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �`7 �o�. Inspector: CONSTRUCTION ` <br /> Facility Address: 400r c!`) . q �-Fk P-AZ t'rc b-j' C'6 <br /> Well Address:_Ot,<D c,PNlJ Total Depth: <br /> WP# U3� 1.. Well#: . 1 Drilling Rig Type: <br /> Soil Boring#: A� LA Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company:Tell/(��(o�j <br /> Driller Onsite: � N k. . Screen Length From: To; <br /> Consultant: t' Filter PackFrom: To: <br /> Geologist: A)r.—F Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes VfNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes VfN0 casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLErlON coMPPLEriiooN <br /> Method: G=nd8urlacs"+ <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft• <br /> tc. ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: 3 <br /> sloitvd � � � <br /> Covered: ElYes ❑No on <br /> g-f pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_ , <br /> Depth to Water: IN 73 ft• — • <br /> Grout Material: C <br /> Gallons of Grout Used: a a <br /> MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Vwell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> El Pressure Gro/Tremie <br /> Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> El Gravity ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> ailons Bags Failons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 31/16 MIX 5% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 35 70 7 <br /> 20 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 />