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r ' 3NIV -JUAVUIIV <br /> Environmental Health Department <br /> —COUNTY— <br /> _ ; <br /> Greatness Grohs here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I l Inspector: , 4e CONSTRUCTION <br /> Facility Address: tte771 g4 <br /> Well Address: jokkg Ma,6_, Total Depth: <br /> WP#- pew(( Well#: S_ Drilling Rig Type: ✓•'}w <br /> Soil Boring#: <br /> Drilling Company: qt Lto") S" tp,n,1,1 Min 2"Annular EHD Seal Verified: I�'Yes ❑No <br /> Driller Onsite: 8 Screen Length From: Z5b To: 72(0 l <br /> h w.` Cs- <br /> Consultant: &Z-')5 "tee40wk- Filter Pack From: To: Zc,q <br /> Geologist: P(\"k'",n Bentonite From: ? To: Z_qs { <br /> Grout From: o To: 1A-0 <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION LTStove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes []No ,casing <br /> If yes, location and distance: n"igt�t <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COi4Tr'iEfFON �PLET7om <br /> Method: Grvind Swfacs <br /> Screening Method: grocn <br /> Verified Chain of Custody: ❑ Yes ❑No ' <br /> it. <br /> #t. <br /> SPOILS <br /> •rte <br /> Contamination Noted: ❑ Yes ❑No = o <br /> If yes, spoils storage Location: st�re� <br /> Covered: ❑ Yes []No <br /> If yes, material: = _ <br /> GROUTING or DESTRUCTION Total Depth: 1%(,?ZV __ <br /> Depth to Water: v �-���"� — ' <br /> IF <br /> Grout Material: rt_e� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: �oSUr,. Casing Type: S}a�H, 1�ss Si1 <br /> a <br /> // <br /> e� ell Installation ❑Well Destruction Blank zAt- Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: • ola <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: Ct _L?tS,.c <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> �� Filter Pack Type/Size: <br /> El Gravity Ll'I remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 541b <br /> gal Ions Bas gall ons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest #Bags 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 z Bentonite per 941b 2.82 4.7 <br /> 7,5 15 3 15 30 3 <br /> I I i I <br /> 10 20 4 20 40 4 k C <br /> 12.5 25 5 2s 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 a ^-G t-- izz. r <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 /> Z.X (0K L'I 5'5 �3 1,,W(�­t5 <br />