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SAN JHOW <br /> —COUNTY <br /> Environme I Health Department <br /> Greatness grows here. <br /> CIA Monitoring Well/Soil Boring Inspection Report <br /> Date: V Inspector: CONSTRUCTION <br /> Facilit Addr s : G <br /> Well Address: vnN CW Total Depth: _ l <br /> WP# ap im 1,7 Well#: ' Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verifieedr: El Yes ❑No <br /> Driller Onsite: Screen Length From: /_ To:� <br /> Consultant: Z Filter Pack From:Dl X- To: r�T_ <br /> Bentonite From: ,O i L— :c <br /> Geologist: - To <br /> / �-Z r <br /> Grout From: Tojristie <br /> Public Water System Onsite: El Yes ❑No COMPLETION El Stove Pipe Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> AVT <br /> SAMPLING <br /> ABOVE-GROCJND CtiAlST1'-80X • <br /> Holding Temperature: cowpLuICN COMPLETION <br /> Method: taro nd Surface <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No _ <br /> If yes, spoils storage Location: stonsrd _ , <br /> sac5on <br /> Covered: ❑ Yes ❑No <br /> g-94 Pack <br /> If yes, material: ?M <br /> x = <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tt. n• <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> W/well Installation ❑Well.Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <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 /> allons Bas Raill ons Bags <br /> Thickest Thinnest gBags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 to zo z 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 I, www.sicehd.com <br />