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- - COUI\1 TY---- <br /> iVlop'toring Well/Soil Boring Inspection Report <br /> 7/ <br /> Date: 1 Inspector: �J ��� CONSTRUCTION <br /> Facility Address: <br /> Well Address: �'W Total Depth: <br /> WP# q 0 Well#: Drilling Rig Type: <br /> Soil Boring#: F>a Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack Frorn: To: <br /> Geologist: W` 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 caSirg <br /> If yes, location and distance: V11— <br /> height <br /> - �F mr <br /> SAMPLING <br /> �vE-r;Rocn.t� �� l'' <br /> Holding Temperature: o� `� <br /> Method: <br /> Screening Method: <br /> i <br /> Verified Chain of Custody: ❑ Yes ❑No — <br /> SPOILS ; <br /> C <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: s <br /> Covered: ❑ Yes ❑No = <br /> If yes, material: <br /> GROUTING or DESTRUCT I N Total Depth: 2� - <br /> Depth to Water: �---- f• n--- — - <br /> Grout Material: 0.41 CP <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: I,�RQ11� <br /> " F Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> ❑Boring Installation 'Boring Destruction Bags Slot Siziz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Nater cement 471b Water Cement 941 Ib <br /> gallons I Bags Qallons Baas <br /> Thickest Thinnest Bags Thickest Thinnest ^9ags E 611t:onife]Cernent Mix 3% Mix 5% I`t�iiX <br /> 2.5 s 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 15 30 3 <br /> _0 20 a 20 40 4 <br /> 125 25 I 5 25 so 5 r (� <br /> 15 30 6 30 60 6 S Q� + b 4(� 9 UY <br /> its 35 7 35 70 7 r c l I0� r I c? <br /> 20 ,'0 a a0 W e �IhQ <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sicehd.com <br />