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S A N J O AQ U I N Environmental Health Department <br /> COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: OL CONSTRUCTION <br /> Facility Address;: (3n <br /> Well Address: Total Depth: I; <br /> WP# pp y�q �5� Well#:, —4 S� Drilling Rig Type: LI�I�(l OLVd <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: C4v' Screen Length From: To: <br /> Driller Onsite: ���i <br /> t <br /> Consultant: �(�M Filter Pack From:- <br /> � To: U� <br /> Geolo ist: Row r�, Bentonite From: To: <br /> g• <br /> Grout From: To: Zt , <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes []No casing <br /> If yes, location and distance: ITTLT height <br /> SAMPLING ABo'E-GROUND c+-plrmaox <br /> H comPLE-rnN COMPLETioN <br /> Holding Temperature: <br /> o=nd Surface <br /> Method: <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> SPOILS ;K= <br /> v — m <br /> = p <br /> Contamination Noted: ❑ Yes ❑No - <br /> - o <br /> If yes, spoils storage Location: .loud <br /> sec5on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: IJr) (0A119 /r1 ft. — n <br /> Grout Material: (�P�LI'C1Prh�Pf'ti MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> 4Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation El 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 /> I-Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> allons Bags Rallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% 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 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 8 40 80 8 <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 />