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3ANALIAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: \`��'�,'L Inspector: CONSTRUCTION <br /> Facility Address: \'3 O' <br /> Well Address: y Total Depth: <br /> WP# 1�'� Well#: i\ Drilling Rig Type: <br /> Soil Boring#: (;Q -1. Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Ly�SG�CQc_��� Screen Length From: To: <br /> Driller Onsite: Yr. <br /> Consultant: �Q�,�Sr, �-jc0��l� i� �-C� Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: El Yes XPO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes �No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-�RCUNn <br /> CC3�'L'=C30N C4iAS57'f-3oX <br /> Holding Temperature: COWL.Eric.N <br /> Method: <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ' <br /> SPOILS <br /> N <br /> Contamination Noted: ❑ Yes /o <br /> If yes, spoils storage Location: Matted - <br /> Covered: ❑ Yes No s ; k <br /> If yes, material: IRR <br /> GROUTING or DESTRUCTION Total Depth:'�;L <br /> Depth to Water: <br /> Grout Material: 1) �,iC.�.1��J� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation Boring Destruction 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 YTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas Rallons Bags <br /> Thickest 7 ' est #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 5% Mix <br /> 2.5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 l0 20 2 Bentonite per 94 Ib 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20_1 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 Stockton, California 95205 1 T 209468-34201 F 209464-0138 1 www.sicehd.com <br />