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"\ SANsA UIN <br /> Q Environmental Health Department <br /> —COUNTY— <br /> ogyP Greotness grows here. <br /> Monitoring Well/Soil Boring Inspect�'ow Report <br /> _�-D �s <br /> Date: Inspector:- CONSTRUCTION t r ,1 ` <br /> Facility Address: J - � J <br /> Well Address: Total Depth: L t, <br /> WP# Well#: Drilling Rig Type: Dui <br /> Soil Boring Min 2"Annular EHD Seal Verified: ❑ Yes <br /> ❑No Ou <br /> Drilling Company: 4, sj / �c w <br /> Driller Onsite: k a w. 0 _ Screen Length'7k*rom: 20 O To: g b W <br /> Consultant: Filter Pack Z From: To: 2 <br /> Geologist:_ a,J ABentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipjwpi.Enoisi <br /> ❑ stie ox <br /> Domestic Well Onsite: ❑Yes ONO aaeing <br /> If yes,location and distance: JHT height <br /> SAMPLING - I V'T � <br /> rteoveLaouNo RMrreox <br /> Holding Temperature: 6oMPLEt1oN Method: G=nd sunaoScreening Method: <br /> Verified Chain of Custody: ❑ Yes ❑No it. g0 - 7,17 <br /> ft. gy •9n <br /> SPOILS <br /> Contamination Noted: ❑ Yes ONO ° _ 1 2•o _ (� <br /> If yes,spoils storage Location: �wnadiu` <br /> seelon 0•i _ 3 <br /> Covered: ❑Yes ❑No — gsw Pau' <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:. <br /> Depth to Water: —ft. 2 r — tt. <br /> Grout Material: A Q . MATERIALS/DEVELOPMENT <br /> Gallo s of Grout Used: Casing Type: <br /> ell Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> kick ��� Filter Pack Type/Size: <br /> ❑ Gravity t�-I remie ❑Other: Type of Method: <br /> Water /Cement 471b Water Cement 941b <br /> M <br /> ns Ba allons Ba s <br /> Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement MIX 3% Mix 5%MIX <br /> 5 1 5 10 1 Bentonite er 47 Ib 1.41 2.47 <br /> 10 2 10 20 2 Bentonite er 94 Ib 2.82 4.7 <br /> 15 3 15 30 3Q25 5 25 50 5 10. r+30 6 30 60 635 7 3540 1 6 1 <br /> 140 <br /> ,52o a,(. +o 9 t! 4 • 0"0 r;i_e q �(� y D e%rr✓ �J 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 I www.sicehd.com <br />