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$AN f OAQUIN Environmental Health Department <br /> �^ —COUNTY— <br /> •„ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: O- '`row Inspector: n4sEs r- CONSTRUCTION <br /> Facility Address: � <br /> Well Address: Total Depth: <br /> WP# 00 D 7 Well#: avw-9 Drilling Rig Type: t 9S <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Caa«.�(� ,7n Lf. Screen Length From: To <br /> Driller Onsite: /7n+»/ Filter Pack From: To: <br /> Consultant: Alhek <br /> Bentonite From: To: <br /> Geologist: FrrZ Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO ��- <br /> '� height <br /> casing <br /> -- ��If yes,location and distance: FF�¢/1 <br /> SAMPLING ABOVE-GROUND CNFiiS1Y BOX <br /> COMPLETION COMPLEnoN <br /> Holding Temperature: CUM Su 1PC* <br /> Method: grout <br /> Screening Method: N1 ,�—n. <br /> Verified Chain of Custody: ❑ Yes ONO n. <br /> SPOILS — <br /> r = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: abtud =_ 8 <br /> a on <br /> Covered: ❑ Yes ❑No = wavw Pack <br /> If yes,material: <br /> t = <br /> GROUTING or DESTRUCTION Total Depth: = tt, <br /> Depth to Water: 'x `/flz-S r tt• <br /> Grout Material: A �'s1`�"^' MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> r. <br /> ❑Well Installation 630ell Destruction s Blank Feet Screen Feet <br /> 0-I& Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> � Type of Method: <br /> ❑ Gravity YTremie ❑Other: <br /> ater Ce 71b Water Cement 941b <br /> allo as aliens Ba s _ <br /> Thickest Thinnest 9Bags Thickest Thinnest #Bags BentonitelCement MIX 3%MIX 5%MIX <br /> as 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94ID 2.82 4.7 <br /> 10 15 <br /> 3 15 30 3 <br /> 30 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 1 40 e0 B 10/16/2017 <br /> A rS-91 7'L <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />