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SANgs10A UIN <br /> Environme I Health Department <br /> —COUNTY— <br /> '`4.C7F Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility A dress: <br /> Well Address: Total Depth: <br /> WP# Well#: WAI l Drilling Rig Type: _T_ J, <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes PNo ill <br /> Drilling Company: <br /> Screen Length From: To: _Z-5 <br /> Driller Onsite: <br /> Consultant: Filter Pack From:? 0 To: <br /> Geologist: k Bentonite From: To: 7 <br /> Grout From: To:�_ <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION I(Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING Asov=-GRotri D <br /> Cob =10N C;*_JR Ty-BOX <br /> Holding Temperature: COWL_TION <br /> Method: Ground Surfscs <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑Nott. <br /> n. <br /> tt. <br /> SPOILS z. <br /> - - o <br /> Contamination Noted: ❑ Yes ❑No - <br /> If yes,spoils storage Location: siod r <br /> ucon <br /> Covered: ❑ Yes 1:1 No = v-10>--X <br /> If yes, material: r . <br /> GROUTING or DESTRUCTION Total Depth: •.=_ <br /> Depth to Water: v —ft. n' <br /> Grout Material: Ge,.*, <br /> Gallons of Grout Used:_i'� MATERIALS DEVELOPMENT <br /> Casing Type: � l� <br /> ell Installation ❑Well Destruction Blank Feet Screen OO Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: 07�9 I "t T, (-.4^ \ <br /> Bags of Cement: J <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity Vremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> gallons Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest tfBags 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 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 i <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 /> ����S <br /> 1368 E. Hazelton venue Stock on,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />