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cJSAN J0A0UIN <br />'2 = Environmental Health Department <br />—COUNTY— <br />\_s�,:. Greatness grows here. <br />J. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: w l Inspector: L4�t hG�.Vv�I✓L e _ CONSTRUCTION <br />Facility Address: al ZLlCYw,,1rjayj I�r� <br />Well Address: Total Depth: <br />WP# Q( 4!g Ll 3 Well#: Drilling Rig Type: <br />Soil Boring#: <br />Min 2" Annular EHD Seal Verified <br />Drilling Company: i <br />Driller Onsite: Screen Length From: <br />Consultant: f--,Xtqq EY1G i✓1p�v'i r�C, Filter Pack From: <br />Geologist: <br />Bentonite From: <br />Grout From: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />CAIVIPI INI(' <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 />If yes, material: <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />11 <br />GROUTING or DESTRUCTION Total Depth: l on <br />Depth to Water: <br />Grout Material: ►Lu&. ce� <br />Gallons of Grout Used: off© <br />❑Well Installation ❑Well. Destruction <br />❑Boring Installation XBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ATremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bags <br />I Water <br />allons <br />Cement 341b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 1 35 <br />7 <br />35 70 <br />7 <br />20 1 40 <br />8 <br />40 80 <br />8 <br />casing <br />��� height <br />-V.--CEW-F <br />Azov—=-GRcuND CHR SW -Box <br />t7JM�'LJ=rICiV COMPLETION <br />Ground suiacs <br />Oroctt <br />ft. <br />ft. <br />K � � <br />z <br />O <br />s{onad <br />! - u-wo' rack <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />ft. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: _ <br />Filter Pack Type/Size: <br />Type of Method: <br />ft. <br />Screen Feet <br />Bentonite/Gement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />—i I <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 />