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Q Environmental Health Department <br /> 'M <br /> —COUNTY— <br /> Greatness grows here. <br /> h Monitoring Well/Soil Boring Inspection Report <br /> Date: O "� Inspector: CONSTRUCTION <br /> Facility AdDress: <br /> Well Address: yN i `>>,}�, �,Q, �� Total Depth: ZZa <br /> WP#_ ya, M Well#: Drilling Rig Type: Iti., .p - "-, 6" <br /> Soil Boring#: <br /> Drilling Company: 5T Min 2"Annular EHD Seal Verified: 1:1 Yes El No <br /> �F <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From:ZLt7' To: 112' <br /> Geologist: Bentonite From:k\2� To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes �No COMPLETION 11Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: Yes ❑No casing <br /> If yes, location and distance:] 3c'� b height <br /> --OA wool& � <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: co t�rEort cC�HM�iEnON <br /> Method: Ground Surfacs <br /> Screening Method: 01 ar«l <br /> Verified Chain of Custody: ❑ Yes El No �tt• <br /> n. <br /> tt. <br /> SPOILS — <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: .bttQd <br /> ssc�an _ <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: - — n• <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: _ <br /> ❑Well Installation ❑Well Destruction Blank eet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: V'AQ tt-,k>4 <br /> Filter Pack Type/Size: Q C,-V,) D <br /> ❑ Gravity Tremie ❑Other: Type of Method: <br /> Water Lawent 471b Water Cement 941b <br /> gallons Bas galll ons Bags <br /> Thick t Thinnest t1 Bas Thickest Thinnest 8 Bags Bentonite/Cement Mix 3%MIX 3%MIX <br /> 2. 5 10 1 Bentonite per 47 lb 1.411 2.47 <br /> 10 2 10 20 z Bentonite per 94 Ib 1 2.821 4.7 <br /> 7.5 3 15 30 3 <br /> 10 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 /> ti off& 2Z 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.coni <br />