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S A 1 Y s J o A Q U I N Cam.. Health <br /> t <br /> .i-s�t �:^- `► COUNTY <br /> Departmen <br /> �����r1r'4•% <br /> C71'POtR(?ss grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: Vu-c CONSTRUCTION <br /> Facility Address: ?c v-- - G'f S 14oC(4' <br /> Well Address: Total Depth: <br /> WP#r0V"1Sq 10 Well#: Drilling Rig Type: <br /> Soil Boring#: tCf--SO tYjO, V1'50. 34Sc- 4250 Min 2"Annular EHD Seal Verified: ❑Yes El No <br /> Drilling Company: fiecy <br /> 4 l Screen Length From: To: <br /> Driller Onsite: V) <br /> Consultant: Filter Pack From: To: <br /> Geologist: S�c%ern 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 aasg <br /> If yes, location and distance: height <br /> _ T <br /> SAMPLING <br /> Holding Temperature: <br /> Method: ' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: <br /> Covered: ❑Yes ❑No man ` _^ <br /> If yes, material: <br /> GROUTING-or-DESTRUCTION. Total Depth:-- <br /> Depth to Water: AIIA <br /> Grout Material: \ACC4J- Gem�v�� MATERIALS DEVELOPMENT <br /> Gallons of Grout Used: 7 (0!gj C1 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> e: <br /> ❑Boring Installation QBoring Destruction Bags Slot Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> 4 Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> aPons --Bags gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 4Bags Benton litel eMent Mix '3% Mix 50A Mix <br /> 2,5 5 1 5 10 1 Bentonite per 4f7 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 40 s 40 ao s <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138-1 www.sicehd.com <br />