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cbl� SANAMUIN <br /> —COUNTY— <br /> Environmental Health Department <br /> °'qo " Greatness grows here. <br /> 9///- Monitoring Well/Soil Boring Inspection Report <br /> Date: 6Inspector: /a CONSTRUCTION <br /> Facility Address: CBS" P� <br /> Well Address: Total Depth: /� <br /> WP# Well#: Drilling Rig Type: C r 7 2 s— <br /> Soil Boring#: SCPT$ SC PTS <br /> Drilling Company: Min 2"Annular EHD Seal Verified: E] Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: �� Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: T height <br /> SAMPLINGnsov>:.GaouN� <br /> Holding Temperature: coitFLErKM �LEnoN <br /> Method: Gmund Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —`--n <br /> n. <br /> n. <br /> SPOILS - — <br /> Contamination Noted: ❑ Yes ❑No =° _ <br /> If yes, spoils storage Location: <br /> s-nod <br /> a ton <br /> Covered: El Yes 1:1 No SCAT-8= 100" .1 <br /> oo' .1 <br /> cn+i+pack <br /> If yes, material: C <br /> GROUTING or DESTRUCTION be De thTotal 1d -F� g — <br /> _ p '�' <br /> Depth to Water: D n- n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ^' Sj A <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity TgTremie ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> Rall s Bas vallons Bags <br /> Thickest Thinnest #Bags 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 2 Bentonite per 94 Ib 2.82 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 40 8 40 80 8 <br /> 1 -3.5 <br /> ba � 10/16/2017 <br /> 1868 E.�9,) <br /> —Jazelton Avenue I Stoc�on, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />