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= c SANJ 0 A 0 U I N <br /> �y Environmental Health Department <br /> COU N T Y <br /> oar Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I1's h i Inspector: NA 5&6w,- CONSTRUCTION <br /> Facility Address: Z-O,% E. Cod;it Rvwe- <br /> Well Address: Total Depth: 2YI <br /> WP# cb aq lob Well#: Drilling Rig Type: sowt <br /> Soil Boring#: ' aS Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company:syrlln�J T-u�-1« f ' <br /> Driller Onsite: Tc7se- Screen Length From: z7b To: Z bb <br /> Consultant: Geo Syn-/ - G.»a✓�o» E" Filter Pack From: ZSsf� To: z g� <br /> Bentonite From:zS1( To: 258 <br /> Geologist: .Sc.c <br /> Grout From: 6 To: 2S4 <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> iii <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETioN COMPLETION <br /> Method: G=ndSLxfw' T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No SY ft. <br /> n. <br /> ft. <br /> SPOILS = �r <br /> Contamination Noted: ❑ Yes 11 No i" = e <br /> 66 <br /> If yes,spoils storage Location: .fott&d = B <br /> sac�on <br /> Covered: ❑ Yes ❑No = i <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: _= <br /> Depth to Water: tt. <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT Y� <br /> Casing Type: 5714�,q MCC Vt& <br /> ❑Well Installation ❑Well Destruction Blank 2-71' Feet Screen /01 Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: .o2a <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> atr C nt 47 Water Cement 941b <br /> allo Bags allons Bags <br /> Thick Thinnest k4 B Thickest Thinnest 4Bags 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 <br /> 15 30 6 30 60 6 mde: ognr Ctwt owl ow //1Zr/79 Na(t"`' <br /> 17.5 35 7 35 70 7 <br /> 20 40 /_s 40 80 a C`(A ,,,X '"gab 8(411103 104 2g,,tllo,,, /fLa <br /> 6, I V 5 1'64�/ '� dl M►Xes . 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />