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Environmental Health Department <br />cy <br />Monitoring Well/Soil Boring Inspection Report <br />' <br />Date: �b Inspector: "J CONSTRUCTION <br />Facility Address: Z.% \S,� <br />J�\ <br />S <br />{ z <br />R10AQUIN <br />, <br />Soil Boring#: <br />Casing Type: <br />—COUNTY- <br />cy�1P.: <br />Greutness grows here. <br />Environmental Health Department <br />cy <br />Monitoring Well/Soil Boring Inspection Report <br />' <br />Date: �b Inspector: "J CONSTRUCTION <br />Facility Address: Z.% \S,� <br />Water <br />gallons <br />Well Address:- .� <br />�. <br />WP# <br />� 0 <br />► �a � 5 � Total Depth: <br />CDrilling Rig Type: <br />Well#: <br />Soil Boring#: <br />Casing Type: <br />N� <br />Drilling Company: <br />Qtyin <br />� u\A <br />2 Annular EHD Seal Verified: El Yes ❑No <br />Driller Onsite: �� <br />lr� <br />Screen Length From: To: <br />Consultant: <br />Filter Pack From: To: <br />Geologist: <br />Bags Sand/Gravel: <br />Bentonite From: To: <br />ty <br />Type/Brand of Bentonite: _ <br />Grout From: To: <br />Public Water System Onsite: <br />❑ Yes <br />❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />casing <br />height <br />ABOVE -GROUND CHRISTY43OX <br />COMPLETION COMPLETTCN <br />D Ground Sumacs <br />grout <br />n. <br />o <br />0 � sbttaC <br />(f a�c�.ion <br />9n 1 Pack <br />If yes, material: ., � <br />%IXQ- <br />GROUTING or DESTRUCTION Total Depth: <br />L, W —ft = ft. <br />Dept to ater. <br />Grout Material: Poj� <br />Water <br />gallons <br />Gallons of Grout Used: <br />X <br />MATERIALS/DEVELOPMENT <br />ABags <br />lv <br />Casing Type: <br />❑Well Installation ❑Well Destruction <br />Blank Feet <br />10 <br />1 <br />Slot Size: <br />❑Boring Installation oring Destruction <br />N�[;J� <br />Bags of Cement: <br />METHOD USED <br />I <br />Bags Sand/Gravel: <br />15 <br />ty <br />Type/Brand of Bentonite: _ <br />❑Pressure Grout ❑Over Drill <br />4 <br />Filter Pack Type/Size: <br />Gravity ❑Tremie ❑Other: <br />4 <br />Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />—Bags <br />Thickest Thinnest <br />ABags <br />Thickest Thinnest <br />4Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />35 1 <br />70 <br />7 <br />20 4008 <br />40 1 <br />80 <br />8 <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 3% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />N' �� J cart d— lcmd <br />Z j �C S-,-I'- <br />� IO � 10/16/2017 <br />f� � ��y��l � le ,fie-�'►-�- <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468- 01 IF 464-0138 1 www.sicehd.corrr, <br />kc)! ? S f�-yep- 0 F-.O—/K- <br />