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<: SQN,=JOQQUIN Environmental Health Department <br /> _. —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: U, CONSTRUCTION <br /> Facility Address: '�)V\ L�,,� <br /> Well Address: Total Depth: <br /> WP# `,,\ C— Well#: \J 1 V--� Drilling Rig Type: <br /> Soil Boring#: 'b' S <br /> L'�5<.A�� Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: <br /> .�p�^t�� <br /> Screen Length From: To: <br /> Driller Onsite: C <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes IAN COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes C N0 casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: co&FLEnON C OOMPoN <br /> Method: cirnc,nd sutacs "+ _ <br /> Screening Method: grotA <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> ft. <br /> SPOILS <br /> m <br /> Contamination Noted: ❑ Yes <br /> IAN a = r <br /> M: C <br /> If yes, spoils storage Location: stand = _a <br /> sac^.,on <br /> Covered: ❑ Yes []No g-„d <br /> pack <br /> If yes, material: i. <br /> N _ .. <br /> GROUTING or DESTRUCTION Total Depth:\'�'j %\5 1\� ►vo -I -- <br /> Depth to Water: N I n' <br /> Grout Material: <br /> Gallons of Grout Used: '6k ��p � MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation [.Boring Destruction gags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> [ ,Gravity N,Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest »Bags Thickest Thinnest Jt Bags Bentonite/Cement Mix 3% MIX 3% 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 <br /> C40 40 1 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />