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COUNTY <br />SA NJ OAQ U IN .."14 Environmental Health Department <br />ft. <br />grout <br />li- <br />ft <br />ft <br />slorta<1 <br />s•clon <br />ft. <br />casing <br />height <br />ca-Fitsrie-pox <br />COMPLETION <br />Ground Surfaas <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 12-12 Inspector: Z. BCA rr.te <br />Facility Address: go+ 3tcI-Rfsiv.e.4.4cie—c4. <br />Well Address: <br />WP# CIO 31-1-li Well#: <br />Soil Boring#: b tA. SV_ 01 <br />Drilling Company: V ftucc; iro.sho.otooji <br />Driller Onsite: 4.4t• CVO g 4?-ir <br />Consultant: k-14.,1 h Pe, Idex <br />Geologist: Eric- <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: E Yes 0No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: 0 Yes <br />P441 <br />COMPLETION El Stove Pipe El Christie Box <br />Domestic Well Onsite: LI Yes ,bin\lo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 0 Yes EN° <br />SPOILS <br />Contamination Noted: 0 Yes 0No <br />If yes, spoils storage Location: <br />Covered: 0 Yes 0No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: No wohirt,C <br />Grout Material: V4i2ok <br />Gallons of Grout Used: 6 <br />LI Well Installation El Well Destruction <br />El Boring Installation Boring Destruction <br />METHOD USED <br />0Pressure Grout 00ver Drill <br />NT Gravity 0Tremie 00ther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest #Bags <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <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 />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen 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 />BentonitelCement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />( RA- \\DS ) flee Li 4itow s of Cdo.‘-tdC <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />10/16/2017