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-4 %t titnvironmen'Tal flealm ueparrr-ent <br /> COUNTY— <br /> _ Greatness q,-ones here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �I /�. Inspector: L,, X �•—'� CONSTRUCTION <br /> Facility Address: -3010# S X!rpajra Jw/ <br /> Well Address: Total Depth: <br /> WP#_ ZSR Sy Well#: Drilling Rig Type: <br /> Soil Boring#: V,-- Lt 003 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: "- <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: pyq—cows Filter Pack From: To: <br /> Geologist: $Y- 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: haight <br /> SAMPLING �3av=-GIaa1i ;a <br /> Holding Temperature: ' }° coMPLETiota <br /> Method: Grvv»d SarFacs <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> i�. <br /> #t. <br /> SPOILS <br /> =r = - <br /> Contamination Noted: ❑Yes ❑No - <br /> If yes, spoils storage Location: z �d _ <br /> Covered: ❑Yes ❑No ; <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water. 'As ttf - <br /> Grout Material: Ae c� ,�-c v <br /> 4•,Q, MATERIALS/DEVELOPM.ENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ®ring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED _/ Bags Sand/Gravel: <br /> ❑Pressure Grout L over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest bBags 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 1 <br /> 10 20 4 20 40 4 <br /> 1 25 5 25 50 5 <br /> 155 30 b 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 9 40 BO 8 <br /> 10/16/2017 <br /> y NZ� <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T' 209468-34201 F 209464-0138 1 www.sicehd.com <br />