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A IV -�u U u I IV Environmental Health Department <br /> —COU NTY— <br /> Greatness grows here. <br /> Moni-wring Well/Soil Boring Inspection Report <br /> Date: it- Inspector: CONSTRUCTION T <br /> Facility Address: iW111 000LftA <br /> Well Address:_ I 'Ia nl w d Total Depth: ZbLf l� <br /> WP# QVC 11 Well#:�-SS Drilling Rig Type: (Y\ ro*v- �I <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: 19<s ❑No <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Z(o <br /> Consultant: <br /> Filter Pack From: To: ?-&L4 <br /> Geologist: r-E, Bentonite From: ZS p,S� To:�,CM <br /> Grout From: 19 To: ZS-0 <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION l�Ktove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING ABovi=-GROUND <br /> Holding Temperature: cc.wL.EmN cCOMPoN <br /> Method: cndss � <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No f- <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: = r - <br /> 3—on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth:7,,&,<' _ <br /> Depth to Water: �- �e — �- <br /> GroutMaterial: ewAk- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: Chu,,•,N� <br /> KM/ell Installation ❑Well Destruction Blank 2St, Feet Screen_ Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: 'to <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: ZN-c. k\-S 4ws <br /> Type/Brand of Bentonite: . ZS <br /> ❑Pressure Grout Dover Drill Filter Pack Type/Size: 2t t S ,k,c.,. t� <br /> El Gravity Z remie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 54lb <br /> gallons Bas 921111 ons Baes <br /> Thickest Thinnest 4Bags Thickest Thinnest #Bags Bentonite/Cement Mix 30/, 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 lb 2.82 4.7 <br /> 7,5 15 3 15 30 3 <br /> 10 20 4 20 40 4 CC <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 (� ,.yf �syv <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br /> i,H -j- 6(4 4-1 1.6 cc,_.�- +'y <br />