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-COUNTY— Environmental Health Department <br /> ..; ,g` Gr:utness grotiFs here (_ � <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 511111 tV Inspector:L� CONSTRUCTION <br /> Facility Address:t� , In ft _ L S W -le, lssc lw� <br /> Well Address: Total Depth: bS <br /> WP# e0 gtiio WeII#: ✓y✓'w Drilling Rig Type: W� S�s� <br /> Soil Baring#: <br /> Drilling Company: Min t"Annular EHDSeal Verified: 11 Yes ❑No <br /> Driller Onsite: eN;V-- Screen Length From:-Sb To: LS' <br /> Consultant: &WE Filter Pack From:_ To: (or <br /> Geologist: iK„n Bentonite From: To: <br /> Grout - From: 0 To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑Stove Pipe p E7Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No aaszng <br /> If yes,location and distance: he�ghe <br /> SAMPLING <br /> !1$OUNO CF1Al5Yl'-80'R . <br /> Holding Temperature: C°WLnQN OOMPLf77ON <br /> Method: cmundSurf o <br /> Screening Method: ¢rpt <br /> Verified Chain of Custody: ❑Yes ❑No fL <br /> n. <br /> SPOILS —ft. <br /> Contamination Noted: ❑Yes ❑No = <br /> If yes,spoils storage Location: <br /> atoned — <br /> Covered: ❑Yes ❑No amen <br /> If yes, material: _ g-V'9 <br /> GROUTING or DESTRUCTION Total Depth: = ,. <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: Se.h YO <br /> ❑Well Installation ❑Well Destruction Blanker—Feet Screen /S Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: . olo <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> El Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 341b <br /> iluns Be lions Ba s <br /> Thickest Thinnest wags Thldmst Thinnest #Bags Bentonite/Cement Mix 3%Mix 5% Mix <br /> as 1 s z 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 In 2 10 20 z Bentonife per 94 lb 2.82 4,7 <br /> 75 35 3 is 36 a <br /> 10 20 4 20 40 4 <br /> 125 25 5 '25 50 5 r� <br /> I530 7 30 770 <br /> 17.5 35 7 35 70 7 S <br /> 20 40 A 40 AO A <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 17 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />