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I <br /> SANS10AQUIN <br /> Environmental Health Department <br /> —COUNTY— <br /> `qr Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> cY ry q� <br /> Date: b b G[J�i �Inspector: I"1 " CONSTRUCTION <br /> Well Address: Total Depth:—+� �(/�J <br /> WP# Well#: y} MW-� Drilling Rig Type: <br /> Soil Boring Min 2"Annular EHD Seal Verified: ❑Yes El No <br /> Drilling Company: <br /> Driller Onsite: eT Screen Length From: To: <br /> Consultant: H r Gill�ll`I 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 El No casing <br /> If yes, location and distance: R height <br /> SAMPLING ABovE{igOUND �X <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: orcuodS t"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> ry I/ <br /> SPOILS ft — yyy ��/ III(rllfffiiiLLLC <br /> 9 <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> Covered: ❑ Yes ❑No = h y l S c <br /> Onk Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTIOP Total Depth: <br /> Depth to Water: AA-eA 6U"e a �� fy; tt• — �tt' 'f / �[!Z� <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: N <br /> 1 Casing Type: <br /> `yJWell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation El Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> �,(_ Filter Pack Type/Size: <br /> ❑ Gravity Lremie ❑Other: Type of Method: <br /> Water / Cemen1471b Water Lament 9416 <br /> Rations Ba Rations Bats _ <br /> Thickest Thinnest It Bags Thickest Thinnest uBags BentOOltefCement Mix 3°/a 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 r <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 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 />