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r o lulu <br /> SQ N 10A0 U I N Environmem -,'Health Department <br /> COUNTY <br /> Greatness grov . .,., <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 3 'Za Inspector: �� �� CONSTRUCTION <br /> Facility Address: tt,1-t-i <br /> Well Address: Total Depth:' <br /> WP# Qo3`1.3oS- Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company:— p., (-1r-1, Min 2"Annular EHD Seal Verified: 0 Yes ❑No <br /> Driller Onsite: Q rt..r••l,o r Screen Length From: 2�— To: 'Ll ! <br /> &e. �..,,�..k-cc, <br /> Filter Pack From:�Sv To: <br /> Consultant: <br /> Bentonite From:'t,?2? l To: Lys <br /> Geologist: �.rr���- L-2Grout From: "%a To: <br /> Public Water System Onsite: ❑ Yes E]No COMPLETION ❑ Stove Pipe <br /> C1Christiel Box t <br /> Domestic Well Onsite: ❑ Yes ❑No r✓aW <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND _ <br /> Holding Temperature: COtr'�PLETION COMPLEr ON <br /> Method: Ground Surf"' <br /> Screening Method: ori <br /> Verified Chain of Custody: ❑ Yes ❑No 1 ft' <br /> ft. <br /> ft. <br /> SPOILS = <br /> •V.K � - O <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: stonad = - <br /> sac5on '- B <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: Zq(, <br /> Depth to Water: ft' <br /> Grout Material: n....k MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type:Aa,. kc_5 Sk <br /> L�Well Installation ❑Well Destruction Blank Z(e 1 Feet Screen t a Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: , ezv <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: 3 l3�eXs <br /> ❑Pressure Grout ❑Over Drill <br /> � Filter Pack Type/Size: <br /> El Gravity EE?rremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest tt Bags Thickest Thinnest ttBags 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 Z 7-7 — ?d V <br /> 15 30 6 30 60 6 a V <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 ('457-2- <br /> _57Z <br /> �Q 10/16/2017 <br /> L <br /> q o <br /> 1868 E. Hazelton Avenue Stkton, alifornla 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />