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SANd0AQUIN <br /> Environmen.dl Health Department <br /> —COUNTY— p <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7 i7'ty Inspectpr: CONSTRUCTION <br /> Facility Address: 2-75 d X ubf r, ooe <br /> Well Address: Total Depth: <br /> WP# 410398/1 Well#:1IEMMMMS Drilling Rig Type: <br /> Soil Boring#:[/.* /09 <br /> Drilling Company: tAva'-a L Min 2"Annular EHD Seal Verified: El Yes ONO <br /> Driller Onsite: Al i"e F, O Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: U—VK Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO -r casing <br /> If yes, location and distance: height <br /> rq- w— —QW7f7 . <br /> SAMPLING Asovr-GnoUNo <br /> COMPLETION COMPLETION <br /> Holding Temperature: COMPLETION <br /> Method: Ground Surlae• �'— <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Nott• <br /> tt. <br /> SPOILS — <br /> Contamination Noted: ❑ Yes ONO = e <br /> If yes,spoils storage Location: <br /> wcion <br /> Covered: ❑Yes ONO _ gnVal pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: C6 t <br /> Depth to Water: 27 `f• tt. tt. <br /> Grout Material: <br /> Gallons of Grout Used: .fag-P & /) }t J/U14 MATERIALS/DEVELOPMENT <br /> � Casing Type: <br /> MWell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Goring 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 /> ❑ Gravity L�Tremie ❑Other: Type of Method: <br /> Water Cement 4711a Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest NBags Bentonite/Ceinent Mix 3% MIX 5%MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 s0 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 />