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IN <br /> --COUNTY-- <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspect r: �G�,c,� Iv.SO CONSTRUCTION' <br /> � _ <br /> Facility/address: 19n PJ64 I, OO ZI AV-t <br /> Well Address: Ma,fd-,?(a Total Depth: <br /> WP# o Well#: _ Drilling Rig Type: <br /> Soil Boring#: R>S Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: _! LUTA•" <br /> Driller Onsite: / Screen Length From: To: <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 El Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑I'd° casino <br /> If yes, location and distance: height <br /> SAMPLING <br /> Holding Temperature: °ham oP' cOMIPLE Iorxi <br /> Method: GrourJst­tacx .�. .�����.�... <br /> 1-1 <br /> Screening Method: gout <br /> Verified Chain of Custody: El Yes ❑No <br /> ti. <br /> SPOILS = i <br /> Contamination Noted: ❑ Yes ❑1\lo = a <br /> If yes,spoils storage Location: _ <br /> lol0lli•_'Q <br /> Covered: ❑ Yes ❑No <br /> If yes, material: (� _— <br /> GROUTING or DESTRUCTIOV Total Depth: - <br /> Depth to Water: n �tf — - `" - • <br /> Grout Material: <br /> ^� <br /> t��IATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> 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 /> OP��ressure Grout ❑Over Drill Filter Pack Type/Size: <br /> IidGravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 4r.Ili Water cement 9"Ili <br /> gallons Bags aallons Bags <br /> Thickest Thinnest I Bags Thickest Thinnest 4"Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2,5 s 1 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 1 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 +5 30 3 <br /> 10 20 4 20 40 4 ` J ( n <br /> 12.5 25 5 25 50 5 pmol q��I��►1V(�� �Z0 <br /> 15 m 6 30 60 1 6 <br /> 17.5 135 7 35 70 <br /> 20 40 B 40 c0 E <br /> 10/16/2017 <br /> '1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 IF 209 464-0138 1 www.sicehd.corn <br />