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19, , ':, JA�V 1'UAIJUIIV Environmental Health Department <br /> ,' —COUNTY- <br /> -,J <br /> COUNTY— <br /> Greatness grows here. <br /> Monirin Well Soil Boring Inspection Report <br /> Date:! 3 ! Inspector: LI CONSTRUCTION <br /> Facility Address: Lb77-) 1tvv, <br /> Well Address: {1`i"l 1 etc k-c, Total Depth: <br /> WP# c`0( 10�cl Welk�- Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: S&tto <br /> Driller Onsite: e� Screen Length From: To: <br /> Consultant: G-+ds, , 1 Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> ` Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWL.ET]QN COMP�ola <br /> Method: <br /> Screening Method: groat <br /> fL <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> ft. <br /> SPOILS <br /> :F <br /> Contamination Noted: ❑ Yes ❑No — o <br /> If yes, spoils storage Location: <br /> &Lorwd = _ <br /> Covered: ❑Yes ❑No <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ft <br /> Grout Material: �t <br /> Gallons of Grout Used:-+SU �, MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout Dover Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity L�remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gall ons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix_ <br /> 2s 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10' 2 10 20 2 Bentonite per 94 lb 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 /> 10/16/2017 <br /> =Rip•- ..j V <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T' 209 468-34201 F 209 464-0138 J www.sicehd.com <br /> 7 4 111b bg S 35, h�'p <br />