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SQ N J OQQ U I N 4 EnvironmenbHealth Department <br /> Q p <br /> —COU NTY <br /> Gi <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: OLI:7 Inspector: CONSTRUCTION <br /> Facility Address: H&T U <br /> Well Address: Total Depth: <br /> WP#00394 Z Well#: Drilling Rig Type: <br /> Soil Boring#: d3 td d t7 6;) 0 gL,—d " 8�f, eel JMin 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 1 Rtda BP1 <br /> Q 1�[r•� ��1. Screen Length From: To: <br /> Driller Onsite: B`Il Filter Pack From: To: <br /> Consultant: !MZ BvL <br /> Geologist: ts,,tr(,.��.. Mo-,�n� 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 AWVE-GROUND <br /> �f"��T3ON <br /> Holding Temperature: CC*WLET1ON <br /> Method: C3toundSurlxs T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> ft. <br /> SPOILS = <br /> 41. <br /> Contamination Noted: ❑ Yes ❑No T` <br /> If yes, spoils storage Location: <br /> sac:on = <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> it VL- <br /> GROUTING <br /> zGROUTING or DESTRUCTION Total Depth: <br /> SAS,SS)S,S4. <br /> IF IF <br /> Depth to Water: C7 tt• —tt. <br /> Grout Material:—r-�CA4 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: , 1.Ss, <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> �,� Slot Size: <br /> El Boring Installation LPBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> e' <br /> Filter Pack Type/Size: <br /> L7 Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags Rallcns Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.821 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 1 70 7 <br /> 20 40 8 40 1 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 />