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(' ¢ L l„•i{ l 6 <br /> --C O Ll N T Y--- <br /> ML'el <br /> oring \[Dell/Soil Boring Inspection Report- <br /> Date:��� InsNector. S.0 CONSTRUCTION <br /> RUCT[ON <br /> Facility Address: 120 1,1" L Lao h AVI <br /> Well Address: — <br /> "1Z0q Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: �— Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Compz <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: �e C Q Filter Pack From: To: <br /> Geologist: � � �p 0 � Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑Nocasing <br /> If yes, location and distance: � � height <br /> ear, <br /> SAMPLING VE-GROUNo <br /> Holding Temperature: ca orxi <br /> Method: GrOurdsL�rt=a <br /> Screening Method: prcut <br /> Verified Chain of Custody: ❑ Yes El No - --�� <br /> SPOILS w — <br /> Contamination Noted: ❑ Yes ❑I\Jlo <br /> If yes, spoils storage Location: — <br /> aln;.�-d <br /> Covered: ❑ Yes ❑No <br /> If yes, material: — <br /> GROUTING or DESTRUCTI N Total Depth: J <br /> De th toWater- �-----jt• — • <br /> p _ <br /> Grout Material: <br /> MATERIALS/DEVELOP MENT <br /> Gallons of Grout Used: ✓- <br /> Aa�j <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> ❑Boring Installation GSlot Size: <br /> Goring Destruction Bags Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity UWremie ❑Other: Type of Method: <br /> l+ater cement 4?Ib N+ater <br /> Cement 94111) <br /> Lallans Bags R811011s Bags <br /> Thickest Thinnest Bags Thickest Thinnest ^Bags Bentonite/Cement i`t+iix 3% Mix 5% rMix <br /> 2,s 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.824.7 <br /> r07. 15 ? 15 30 3 <br /> 20 4 20 40 4 <br /> 25 5 25 50 5 <br /> 1'.5 35 't 55 70 T <br /> 20 40 <br /> C(• C •'wW 1 <br /> ' 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />