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SA NJ OH M <br /> Environmel I Health Department <br /> —COUNTY— <br /> Greatness <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoriring Well/Soil Boring Inspection Report <br /> Date: Inspector: r�' CONSTRUCTION <br /> Facility Addre s: <br /> Well Adr s: �,�� Total Depth: C lA <br /> W P# �•/A�o� 1-7, Well#:e� Drilling Rig Ty� J <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: El Yes ❑No ' <br /> Drilling Company: -f ��' (� � 'LJ <br /> Driller Onsite: 144A-14— o-f G Screen Length From: 4j Q To: tO <br /> Consultant: Filter Pack From: Ill (� To: <br /> Geologist: Bentonite From: 1 , To:1_ <br /> Grout From: To__: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION El Stove Pipe [Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ASOVE-GROUND T <br /> Co&FLET10N CHRMry-BOX <br /> Holding Temperature: COMPLETIONMethod: around Surfxs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No .� ft- <br /> ft. <br /> SPOILS ft• - __ <br /> `N <br /> Contamination Noted: ❑ Yes ❑No - <br /> If yes,spoils storage Location: atoll <br /> sac5on — <br /> Covered: ❑ Yes ❑No <br /> g- Pack <br /> If yes, material: =x <br /> :x — <br /> GROUTING or DESTRUCTION Total Depth: . =_ <br /> Depth to Water: n. tt• <br /> Grout Material: ". (� <br /> ;'Well <br /> ll s of Grout Used: MATERIALS/DEVELOPMENT � 2 N <br /> Casing Type: •�_� <br /> Installation ❑Well.Destruction Blank fZ FeetO�Screen �_ Feet <br /> ❑ ^ <br /> ❑Boring Installation <br /> Slot Size: o, 0 .,Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: Z' <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall ns Bags allons Bags <br /> Thickest Thinnest kBags Thickest Thinnest 9Bags 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 i <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 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> [r , 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton �Iifornia 95205 T 209 468- <br /> , I 468-34201 F 209 464-0138 1• www.sicehd.com <br />