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SAN <br /> dOAHINO <br /> < + Environme& Health Department <br /> —COUNTY— <br /> `•'9F Greatness grows here. <br /> Monitoring� `�Well/Soil Boring Inspection Report <br /> Date: /N/Inspec`or: X CONSTRUCTION <br /> Facility Adres : JV r (__ <br /> Well Address: c—.-- Total Depth: <br /> WP# 0 Well#: Drilling Rig Type: <br /> Soil Boring#: JT­ w �� –" Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: T' <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: 6<A9 Filter Pack From: To: <br /> Geologist: Bentonite From: To:CAL 4!4x.AA� � <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 ABOVE-GROUND <br /> Holding Temperature: COWLETION COOMPtETioN <br /> Method: Ckvund Suiace <br /> Screening Method: PZ arm <br /> Verified Chain of Custody: ❑ Yes ❑No .L—ft. <br /> fi. <br /> SPOILS . <br /> Contamination Noted: ❑ Yes �No — <br /> If yes, spoils storage Location: <br /> sawn } <br /> Covered: ❑ Yes ❑No — 9--1Pack <br /> If yes, material: / 5��1 tt\ 4-._ <br /> JIN <br /> GROUTING or DESTRUCTION Total Depth: ' - <br /> Depth to Water: n. F IFn' <br /> Grout Material:---' MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: -7,r Z <br /> T Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> �� Filter Pack Type/Size: <br /> 62/Gravity 5?fremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Baas lZall ons Bags <br /> Thickest Thinnest 41 Bags 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 /> 1s 30 6 90 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> c� n I � ��. 10/16/2017 <br /> 1868 E. Hazelton enUII stockk n, California 95205 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br /> I l <br />