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)AIN- uKL)u I IV Environmental Health Department <br /> COUNTY <br /> -- - Greatness grams here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: t tS 1 Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: )igM Total Depth: 7.0 <br /> WP# p,:0f1-1-7 VJellt :�w Drilling Rig Type: 5"w'� <br /> Soil Boring#: -A'0 <br /> Drilling Company: t (I c.vJ T,.,a,�� Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Driller Onsite: 3-05-2, Screen Length From:ZS/ To: 2y/ <br /> Consultant: [7eoS4�,}..mac, Filter Pack From:� 41 To: 2_f,Z <br /> Geologist: � Bentonite From: 23S_ To: 2-LI( <br /> Grout From: 0 To: 1-3 -1 <br /> Public Water System Onsite: ❑ Yes ❑NoCOMPLETION EO-Save Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: halglit <br /> SAMPLING AW VE-GROUND .w. 17 <br /> Holding Temperature: CO WLEMN eC.o;~a LETii0r4 <br /> Method: c=nd Suriaca <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No fL <br /> i�. <br /> SPOILS ,aF <br /> :Y _ __ a <br /> Contamination Noted: ❑ Yes ❑No rF — o <br /> If yes, spoils storage Location: sir <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 237 — <br /> Depth to Water: F �w " <br /> Grout Material: nCNt <br /> Gallons of Grout Used: �.' <br /> MATERIALS/DEVELOPMENT <br /> � Casing Type: 5its s ,e_,i <br /> R ell Installation ❑Well Destruction Blank 'LSI Feet Screen (-to Feet <br /> Slot Size: . (7W <br /> El Boring Installation El Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: 0 �nKn <br /> ❑Pressure Grout El Over Drill Type/Brand of Bentonite: 3 6wt 11 s N <br /> Filter Pack Type/Size: <br /> ❑ Gravity li?fYemie El Other: Type of Method: <br /> CC1y ew►1A' w" -. <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gall ons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest tlBabs 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 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 3 �\ fuA`Gt k 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T' 209 468-34201 IF 209 464-0138 1 www.sicehd.com <br /> Z'A Seaw" 'k- U"' � In 6a�-6 <br />