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0 SA NUJ DAQ U I N Environmental Health Department <br /> • (� iw'•'` `J —COUNTY— <br /> ' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: YlCONSTRUCTION r <br /> Facility Address: �o/oo vla.j <br /> Well Address: Total Depth: <br /> WP#0D 109,0 Well#: Drilling Rig Type: <br /> Soil Boring#: 2-5 —1-F{.-006- <br /> Drilling Company: (J-t�- �jr S�„�Sw•{w,c, �lo�,.du•-- Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: Rio.� .l.ILLrv.n�u Screen Length From: To: <br /> Co r� Filter Pack From: To: <br /> Consultant: A 1E <br /> Geologist: (2'rLr j)d 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: Teg zt ; <br /> SAMPLING ABOVE-GRCUNo <br /> co► �;iota usw-sox <br /> Holding Temperature: ct ��nor� <br /> Method: GrWnd Smf"' <br /> ..m <br /> Screening Method: e*° <br /> Verified Chain of Custody: ❑ Yes ❑No 's <br /> tt_ <br /> SPOILS QF= <br /> Contamination Noted: ❑ Yes ❑No = o <br /> If yes, spoils storage Location: <br /> mon <br /> Covered: ElYes ❑No w _ <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: =' <br /> Depth to Water: <br /> Grout Material: n•.. C MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ° <br /> ,.,,. <br /> ,,.// Casing Type: <br /> ❑Well Installation aX ell Des ruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation El Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout Dover Drill Type/Brand of Bentonite: <br /> �� Filter Pack Type/Size: <br /> El Gravity ? remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> gallons Bags gall ons Bags <br /> Thickest Thinnest 4Bags 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 lb 2.82 4.7 <br /> 7,5 15 3 15 30 3 1 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 /1 1 <br /> is 30 30 0 <br /> 17.. 7 7 75 35 7 35 70 7 ✓ � �'` <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T' 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />