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i�.12. ',. %im coulTY— <br /> Ayui 19 ti'ivif'olilPlorlmi meami uepa'rtment <br /> Greatness Grans Here. <br /> • Monitoring Well/Soil Boring Inspection Report <br /> Date:• -11 Inspector: L.--e CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# M I qu ft Well#: Drilling Rig Type: <br /> Soil Boring#: 14 — k—aj-1 Ps —�K oo4 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Vig ki fir►I\Y✓1 <br /> Driller Onsite: P'--j r—I Screen Length From: To: <br /> .c. Filter Pack From: To: <br /> Consultant: WaJk4,�c,Q kww� <br /> -�-� � <br /> Geologist: v.A 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 teasing <br /> If yes, location and distance: haight ; <br /> SAMPLING cHatsTy_ <br /> Holding Temperature: 0°w �1°N CO LETiON <br /> Method: <br /> Screening Method: eft <br /> Verified Chain of Custody: ❑ Yes ❑No f' <br /> r�. <br /> #t. <br /> SPOILS = __ <br /> AY <br /> Y � O <br /> Contamination Noted: ❑Yes ❑No <br /> If yes, spoils storage Location: <br /> Covered: ❑Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:; <br /> IF <br /> Depth to Water: � '1 _wew-1ft - -- n `— <br /> Grout Material: el-C r% MATERIALS/DEVELOP M.ENT <br /> Gallons of Grout Used.^-904 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout Dover Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity [9<remie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 941b <br /> !Ions Bas gallons Bags <br /> Thickest Thinnest kBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10, 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7,5 15 3 15 30 3 i <br /> 10 20 4 20 40 4 I (y l4 1 1 i D <br /> 12.5 25 5 25 so s a <br /> 15 30 6 30 so 6 / q <br /> 17.5 35 7 35 70 7 J <br /> 20 40 B 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 I www.sicehd.com <br /> u :•► <br />