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SWARM <br /> M <br /> couNrY— Environmental Health Department <br /> Greatness grows Frere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:41 1-is. Ick Inspector: Ko Sae+ern CONSTRUCTION <br /> Facility Address:15,:).00 ftkaC e- fire <br /> Well Address: Total Depth: <br /> WP# C04b-a :-+ Well#: Drilling Rig Type:'' <br /> Soil Boring#:?)Wt _ j�a,02, #b4. W5 , *lo 4} Min 2"Annular EHD Seal Ve1`ified: El Yes ❑No <br /> Drilling Company:KQAI-A-1 S ASsoc;.cTPs <br /> Driller Onsite:mm Cy)ay& - Screen Length From: To: <br /> Consultant: {'coUA-Tec Filter Pack From: To: <br /> Geologist:_ )NON ne 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 /> SAMPLING ABC1VE-bRV1JND <br /> oot LTu�N ts1Y-sox <br /> Holding Temperature: <br /> Method: t3rctind sufi�ca <br /> Screening Method: pr <br /> Verified Chain of Custody: ❑ Yes ❑Noft- <br /> ft. <br /> SPOILS — <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: v <br /> ickxtt$d •�:_ <br /> Covered: ❑ Yes ❑No — <br /> Ifyes,material: :, •• <br /> GROUTING or DESTRUCTION Total Depth: q-+ &4= �O <br /> Depth to Water: rine. or)v 'a1 sct:N6 <br /> Grout Material: Nea c,ey.eor -A2'\5 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: %co \ *r. <br /> Ab <br /> b Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> XPressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity [ATremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bads Rallons f a <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Berii!onifetcement Mix17i <br /> 5% i(�1'IiX <br /> z.5 5 1 s 10 a E3entonife per 47 lb <br /> 1.412.47 <br /> 020490 <br /> z 10 20 2 Bentonite per 94 lb 11•.7 <br /> 3 15 30 3 <br /> 4 20 40 4 <br /> s zs 50 s <br /> B 30 60 6 <br /> 7 35 70 7 <br /> 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E.Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 I www.sicehd.com <br />