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Utry C • <br /> . g= SAN.DJOAQUIP Environmental Health Department <br /> —COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report o <br /> Date: � V Inspector: CONSTRUCTION �r � ^� � <br /> Facility Address: <br /> Well Address: Total Depth: b-g sP <br /> H t <br /> WP# U T- c a Well#: Drilling Rig Type: DZq- <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: Ales ❑No <br /> Drillin Company' A <br /> g An �1P J Screen Length From: µU To: J S <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: <br /> Bentonite From: To: 3 $ <br /> Geologist: M Grout From: 0 To: 31c. <br /> Public Water System Onsite: ❑ Yes Pko COMPLETION 11Stove Pipe lgiChristie Box <br /> Domestic Well Onsite: ElYes o caeing <br /> height <br /> If yes, location and distance: —EWT <br /> SAMPLING 6C / � AeovE-GROUND cwatsrr-BOX <br /> CONFLErION COMPLETION <br /> Holding Temperature: <br /> �.��.Ground su+x. <br /> Method: llr-ts <br /> grout <br /> Screening Method: i h <br /> 3S g, <br /> Verified Chain of Custody: ❑ Yes ❑No _ $ft. _it. <br /> ro _ <br /> SPOILS C'k4�zf"3 -Fc, ciTtej ��S/ AVT� 7 a - <br /> Contamination Noted: LJ Yes l Ade <br /> If yes, spoils storage Location: , \ eloeaC o 3 <br /> section = i <br /> Covered: ❑ Yes L�No _ gravel pack <br /> If yes, material: / \ <br /> GROUTING or DESTRUCTION Total Depth: r' <br /> ' SS t S� n <br /> �I-0 <br /> Depth to Water: bag <br /> Grout Material: do-' ryu'+� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: r°VC Sck q <br /> [NSlat Size:ell Installation ❑Well Destruction ()dt7r� Blank Feet ©a�reen /> Feet <br /> t.Vt <br /> ❑Boring Installation El Boring Destruction, t©AMn Bags of Cement: <br /> METHOD USED k� Bags Sand/Gravel: L 0. <br /> a� M Type/Brand of Bentonite: 0 � <br /> ❑Pressure Grout ❑Over Drill v o`�� Filter Pack Type/Size: <br /> El Gravity remie ❑Other: Typeo ethod: <br /> a� 0 :�r ib loC'�—h k cu,at <br /> Water <br /> cement water Cement 941b 61Lkiao d61+� n. <br /> lions Bags allons Ba .a-py <br /> Thickest Thinnest IBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix5"/o Mix c� � <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 p �,n- <br /> 5 10 2 10 20 2 Bentonite er 94 lb 2.82 4.7 I <-t�. <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 1�a <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 e <br /> 20 40 40 so r 8 Cyt p!L <br /> - ZZq V1� 1 q�� 7V� 10/16/201 <br /> 1868 E. Hazelton A en e 1 o kton iifor a it 'T 209 468-3420 IF 209 464-0138 1 www.sicehd.com <br />