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-�: 0 Ir duriwuI I tthviro1111 en`all rleaiM LieparTMerrit <br /> , <br /> ' .tet"• —COUNTY— <br /> Greatness grams here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: II f3 Inspector: CONSTRUCTION T <br /> Facility Address: -7a top S ,r r <br /> Well Address: Total Depth: <br /> WP# O*38 a�"a Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: {X 4,L Filter Pack From: To: <br /> Geologist: B rjd <br /> 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: height ; <br /> SAMPLINGav� <br /> Holding Temperature: �WLETI0N c�c��oN <br /> Method: crvvnd Surfac* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> ii. <br /> #L _ <br /> SPOILS AQF <br /> Contamination Noted: ❑ Yes ❑No -If yes, spoils storage Location: rr�d <br /> Covered: ❑Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: �5 <br /> Depth to Water: t - JL_ <br /> Grout Material: Y�•t. C MATERIALS/DEVELOP M.ENT <br /> Gallons of Grout Used: 3 84 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ing 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 /> 11�Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> gallons Bas gall ons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest »Bags Bentonite/Cement Mix 30/. 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 Bentonife 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 /> 15 30 b 30 60 6 <br /> 17.5 35 7 35 70 7 J <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T' 209 468-3420 1 F 2D9 464-0138 1 www.sicehd.com <br />