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JAIVJUNVUIIV Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Moniiuring Well/Soil Boring Inspection Report <br /> Date: ) q Inspector: CONSTRUCTION z <br /> Facility Address: 1(.-7-7-7 ".9,j 6-d -w <br /> Well Address: 110Y11 Total Depth: <br /> WP# poi y Well#:_ tow—.? Drilling Rig Type: <br /> Soil Boring#: F Y./ <br /> Drilling Company: Yt'ft. ,) J,y f- Min 2"Annular EHD Seal Verified: es ❑No <br /> Driller Onsite: <br /> Screen Length Frorr Filter Pack From: To: 2_4P_,— <br /> J� <br /> Consultant: (ltoswr r To: �- <br /> Geologist: <br /> Bentonite From- To:rarer <br /> Grout From: -Q� To: -ywh - <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION 1-Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ASovE-GROU ID <br /> Holding Temperature: cowLE-noN <br /> COMPLETiON <br /> Method: Gr7ind S`rf'C' <br /> Screening Method: of <br /> Verified Chain of Custody: ❑ Yes ❑Nom <br /> ft. <br /> #t. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No = e <br /> If yes,spoils storage Location: stir <br /> soon w � <br /> Covered: ❑Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 2z _ _— <br /> Depth to Water: %-L— <br /> Grout Material: a,,,A- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> ^/ Casing Type: <br /> L7S <br /> Well Installation ❑Well Destruction Blan��- Feet ScreenFeet <br /> Slot Size: •--jba-- <br /> ❑Boring Installation El Boring Destruction Bags of Cement: ' <br /> METHOD USED Bags Sand/Gravel: -- <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: !_t r! ��. <br /> Filter Pack Type/Size: <br /> ❑ Gravity �ie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> Ilons Bas 221111 ons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 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 /> i 1 i I <br /> 1 20 4 20 40 4 _ ,t P J e p�.r r.�iE� S", c� <br /> 12 <br /> .5 25 s 30 50 s r� <br /> / <br /> 15 30 6 30 60 6 !•j (�.tin D ( C n 1 I � ' Ly (f <br /> 17.5 35 7 35 70 7 j <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br /> q P'td,'S eC L{? (t 65S <br />