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Date/ /Z4 Inspector: <br />Facility Address: 1 ) 0 ifr1cia444 <br />Well Address: <br />WP# DO LI -14 5 Well#: <br />Soil Boring#: CP --9 <br />Drilling Company: /14 ri 7;11-Zikti <br />Driller Onsite: <br />Consultant: 6--v"ot-cio <br />Geologist: <br />0 Yes E No Verified Chain of Custody: <br />SPOILS <br />oring Destruction Boring Installation <br />METHOD USED <br />CI Pressure Grout DOver Drill <br />D Gravity remie DOther: <br />1868 E. Hazelton Avenue I St ckton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />S AN d OAQ Ul N <br />1-111‘ - — COU N TY <br />7113:e2 <br />Greatness grows hen <br />Public Water System Onsite: D Yes 0 N o <br />Domestic Well Onsite: LI Yes 0 N o <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Contamination Noted: 0 Yes 0 No <br />If yes, spoils storage Location: <br />Covered: LI Yes lilNo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />Well Installation DWell Destruction <br />Water <br />gallons <br />Cement 47Ib <br />Bags_ <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest # Bags <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <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 />Environmental Health Department <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />10/16/2017 <br />Monitoring Well/Soil Boring Inspection Report <br />CONSTRUCTION <br />y- <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes EINo <br />To: <br />To: <br />To: <br />To: <br />COMPLETION E Stove Pipe <br />casing <br />height <br />CI Christie Box <br />CHAISTY-BOX <br />COMPLETION <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: