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�r �ANLJUAVUIN Environmental Health Department <br /> —COUNTY <br /> 1 <br /> Greatness grows hers. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: O 1 Inspector: Lor CONSTRUCTION <br /> Facility ddress: Z3 2.23 5•. ,•• ¢�1 <br /> Well Address: _ Total Depth: <br /> WP# �o3S�Z?_ Well#: _ Drilling Rig Type: <br /> Soil Boring#: bi to-t-1 _ <br /> Drilling Company: f�—ro�]w� Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Screen Length From: To: <br /> Driller Onsite:int <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: 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 �z=ins <br /> If yes, location and distance: n_=ght <br /> —ww-: <br /> SAMPLING ABOVE-GROUND Ch'FilsTy-BoX - <br /> Holding Temperature: CCVPLFi;ON co+a=t_�rior� <br /> Method: GnXinds wira <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No 's <br /> tt_ <br /> SPOILS = .:.. <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: 2-d <br /> Covered: ❑ Yes ❑No _ <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: (,a-fi5 <br /> Depth to Water: t_ <br /> Grout Material: <br /> Gallons of Grout Used:— p �- o MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation [4• ring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity Vr-emie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gaill ons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest pBags BentoniteXement MIX 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10' 1 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 1 3 15 30 3 <br /> 20 4 20 40 4 <br /> g20 <br /> 25 5 25 50 5 /5 G u� �� l5 ( l <br /> 30 6 30 60 6 1 5 J t, 3 y, `I 1 <br /> 35 7 35 70 7 R 1 b L <br /> 40 a 4o 80 e ui� �lzv `1 L47 bb I <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 />