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;-+ tri I'll-s'J uAy u IIIc <br /> tClV1f Oilt�lef11 1 Fi�clri i uupdi 7�ent <br /> I —COUNTY— <br /> Greatn.Fss Grcrcs ;.ire. <br /> e. <br /> Well/Soil Boring Inspectia.i Report <br /> Date: l\ 1 b Inspector: {.er CONSTRUCTION T <br /> Facility Address: ti a <br /> Well Address: uo&n Total Depth: Z L11 <br /> WP# b � O O-3 CMWell#: P W-Lk!�' Drilling Rig Type: SQ. <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 2 a4 ex Screen Length From: 'Z,5 0 To: 7J"W <br /> Driller Onsite: <br /> Consultant: Filter Pack From: 2 1q To: 2 / <br /> Geologist: � S- <br /> Bentonite From: l"f To: Z `� <br /> v 5+ `�It�V"zl Grout From: To: Z <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No <br /> (t. asino . <br /> If yes, location and distance: aigtit <br /> OLSAMPLINGHolding Temperature: eiapC*iR`-o `'1 <br /> 'L Method: c undS" ' ^e <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> -2.3 o fL _ ZF1 <br /> SPOILS = Q <br /> PQM' <br /> Contamination Noted: ❑Yes ❑No <br /> If yes, spoils storage Location: <br /> Covered: ❑Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTIO Total Depth:`)1L <br /> Depth to Water: A -fL �— — A. <br /> GroutMaterial: MATERIALS/DEVELOP M.ENT <br /> Ga�llons of Grout Used: Casing Type: A�J car C -k AsI S/ V <br /> Tell Installation ❑Well Destruction ��jk' ) Blank?F7 Feet Screen f.� IFeet <br /> }� Slot Size: � �2V <br /> ❑Boring Installation El Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: tT7-3 "IJ <br /> Type/Brand of Bentonite: 3 <br /> ❑Pressure Grout Dover Drill Filter Pack Type/Size: <br /> ❑ Gravity (�mie ❑Other: Type of Method: Al V- fvt in, �o <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10' 2 10 20 2 Bentonite per 94 lb 2.821 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 1 40 8 40 Be 8 <br /> 0/16/2017 <br /> &t*C���� �� �o��, 5 � 3Q o� 'w Civ �� uv � s�1-t <br /> 1868 E-H. lto Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 www.sice com I Z QonK <br />