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"- )AR.,J UA V U 1N Environmental Health Department <br /> —COUNTY— <br /> Greatness gra-ws mere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I Z-V I L7 Inspector: CONSTRUCTION <br /> Facility Address: '11 l wM �I <br /> Well Address: Total Depth: cLs-,a- <br /> WP# 01 311 Z'�q Well#: W _tti- Drilling Rig Type: M�•d �e��n <br /> Soil Boring#: <br /> p,r, Min 2"Annular EHD Seal Verified: Cy Y s ❑No <br /> Drilling Company: 1. <br /> Driller Onsite: (l,,,.o,Le.. _ ear, � a , Nt <br /> Screen Length From:�o To: �L D <br /> Consultant: (�y e-c� — Filter Pack From: bo To: 19 <br /> Geologist: ('A„��t,��, Bentonite From: Sv To: <br /> Grout From: -o To: -TD <br /> Water System Onsite: El Yes ❑No COMPLETION LKStove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CC WLETSON COMPLETiON <br /> Method: G"ndSwfra <br /> Screening Method: gfcut <br /> Verified Chain of Custody: ❑ Yes ❑Noy <br /> fE. <br /> ft. <br /> SPOILS <br /> � _ - a <br /> Contamination Noted: ❑ Yes ❑No — o <br /> If yes, spoils storage Location: sdo <br /> r - <br /> "-.On = _ <br /> Covered: ❑Yes ❑No 'w <br /> If yes, material: __ <br /> GROUTING or DESTRUCTION Total Depth: SO <br /> Depth to Water: 1� F <br /> Grout Material: ^,cik- c <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> --// Casing Type: <br /> L�Well Installation ❑Well Destruction Blank -1-0 Feet Screen 'Z- Feet <br /> ❑Boring Installation El Boring Destruction Slot Size: .A"y-y <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: -Z--1 <br /> Type/Brand of Bentonite: Ll <br /> ❑Pressure Grout Dover Drill <br /> _� <br /> �� Filter Pack Type/Size: <br /> El Gravity E�l'remie ❑Other: Type of Method: <br /> Mater Cement 471b Water Cement 941b <br /> 9paIlons Bas gall ons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest rt Bags Bentonite/Gement 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 y (r�Ci� fir! <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 �� ��'� ��j 11 <br /> / 10/16/2017 <br /> 1868 E. 1HI"azelton Avenue I Stockton, C ifornia 95205 1 T' 209468-34201 IF 209464-0138 www.sicehd.com <br /> ( 4� W't �b <br /> 3D 13) K 1 <br />