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SANr10AQUlw <br /> Y Environmental Health Department <br /> —COUNTY— <br /> 'c9GFORNP Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �Z.� Inspector: 1�,Njr)'o CONSTRUCTION <br /> Facility Address: <br /> Well Address: 23 y ;� �Uj Q�IuJ�, Total Depth: <br /> WP# Well#: Drilling Rig Type: -- <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling CompanyJ*34,, C CAQ`it C tjp W WN <br /> Driller Onsite: ''�'�F,-p�J Screen Length From: To: <br /> Consultant: Filter Pack From:_ To: <br /> Geologist: Bentonite From:�y_ To: Q C*- <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes IN COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes LNo casing <br /> If yes, location and distance: height <br /> -7, e <br /> `.SAMPLING AgpyE.GRpUNp <br /> Holding Temperature: COMPLETION ��oN <br /> Method: GiroundSuiacs + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No tt. <br /> tt. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: <br /> ssc7on — <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION To al Depth: <br /> Depth to Water: n _ • <br /> Grout Material: 1g NK-' N" C1, l,Vl S <br /> MATERIALS/DEVELOPMENT �I <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation ❑Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑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 /> wall] s Bas gallons Bags <br /> 'thickest Thinnest 4Bags Thickest Thinnest VBags 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 /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 7D 7 <br /> 20 40 8 40 80 ( 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />