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SAKA0A0UIN <br /> Environmental Health Department <br /> '1 <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> \/a+nce Wov�q� <br /> Date: 7LiILOW Inspector: D-20YOdra CONSTRUCTION <br /> Facility Address: ?ZALA(09 C.yine Ave. <br /> Well Address: Total Depth: <br /> WP# 191 Well#: Drilling Rig Type: J <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: ❑ Y []No <br /> Drilling Company:masov_�7 Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes KNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes V No casing <br /> If yes, location and distance: TffLT height <br /> SAMPLING ABOVE-GAUD <br /> Holding Temperature: �t F�rtoN CCoMPLEMN <br /> Method: G=nd Sumacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> ft. <br /> ft. <br /> SPOILS <br /> Mr _ <br /> Contamination Noted: ❑ Yes ❑No <br /> .R' C <br /> If yes,spoils storage Location: stottQd <br /> s�cson <br /> Covered: ❑ Yes ❑No = sx-'�wl-* <br /> If yes, material: <br /> RTING < <br /> OUr DESTRUCTION Total Depth: C � :- =_ <br /> Dept to Water: n• n' <br /> Grout Material: sa(G <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: (/ (X S L <br /> KWell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: C U(' <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity UKTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 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 1 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 L40 1 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 />