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3AB) SsJUAIJU N Environmental Health Department <br /> ..KI —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: k) =" jig Inspector: xto CONSTRUCTION <br /> Facility Address: b-to N Vj S� <br /> Well Address: Total Depth: <br /> WP#_ 00 -3'cg Well#: Drilling Rig Type: <br /> Soil Boring#: e> (S?_ D `, • 4 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> 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 ❑No COMPLETION ❑Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ASCv=--I?Roi_rao <br /> cor:;n;�;Lora :Isry-aax <br /> Holding Temperature: cry=-Dior <br /> Method: cx sr <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> ra. <br /> SPOILS <br /> Contamination Noted: ❑Yes El No = e <br /> If yes,spoils storage Location: <br /> Covered: ❑Yes ❑No <br /> if yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 1_1 4k- <br /> Grout Material: n C*,t- C e�"'- <br /> Gallons of Grout Used:- M _ 2e , 1v,, ^S., .—S' <br /> MATERIALS/DEVELO PMENT <br /> J Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> �� Filter Pack Type/Size: <br /> [El Gravity LWfremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> ailons Bags gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest #Bags 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 lb 2.82 4.7 <br /> 7,5 15 3 15 30 3 1 1 1 <br /> 1 20 4 20 40 4 2 S� t 1 O -3, {'� hc.�p <br /> 12..5 25 5 25 50 5 Q 1 iC <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 1 L o 4-1 I <br /> 20 40 8 40 80 8 6 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue j Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />