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041149u14uU111 Environmental Health Department <br /> Grea.ness grows here. <br /> M itorin Well/Soil Boring Inspection Report <br /> � <br /> Date:�D��� Ins ector: CONSTRUCTION <br /> Facility Address: y�� W • ( i�A <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: u2 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company:77 Q YrGC.6h <br /> �� Screen Length From: To: <br /> Driller Onsite: -r'-+a Filter Pack From: To: <br /> Consultant: 712 r rrtC6V1 <br /> �( <br /> Geologist: � r <br /> 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: T height T <br /> SAMPLING ASO e-GRCU,D <br /> COWL=,�N <br /> Holding Temperature: COMPLETION <br /> Method: c��""as"'f"' <br /> Screening Method: procrt <br /> Verified Chain of Custody: ❑ Yes ❑No ' <br /> f3. <br /> tt. <br /> SPOILS . . <br /> .yK p <br /> Contamination Noted: ❑Yes ❑No = o <br /> If yes,spoils storage Location: storsd <br /> sacyan <br /> Covered: ❑Yes ❑No — g,f„ipack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: c <br /> Grout Material: (5Y � tx.lLtps, <br /> Gallons of Grout Used: I I) nQ11 MATERIALS/DEVELOPMENT <br /> `'- Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ' Slot Size: <br /> ❑Boring Installation VBoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout Dover Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity 14remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Baas swallons 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 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 60 6 � <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1368 E. Hazelton Avanue I Stockton,California 95205 7 209 46&3420 I F 269 4E4-0138 I www.sicehd.com <br />