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Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: \ �L— Inspector: CONSTRUCTION <br />Facility Address: `'` 5 �. �5� LZ <br />Well Address: " Total Depth: <br />WP# \Ati 1 `� Well#: —P 6A—_ Drilling Rig Type: <br />Soil Boring#: (.._Q - \—L. � \ \ I �-o Min 2" Annular EHD Seal Verified: ❑ Yes E] No <br />Drilling Company: �1P,Q ��- ►A <br />Screen Length <br />3A NAUAQUIIN <br />To: <br />—COUNTY— <br />METHOD USED <br />Greainess grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: \ �L— Inspector: CONSTRUCTION <br />Facility Address: `'` 5 �. �5� LZ <br />Well Address: " Total Depth: <br />WP# \Ati 1 `� Well#: —P 6A—_ Drilling Rig Type: <br />Soil Boring#: (.._Q - \—L. � \ \ I �-o Min 2" Annular EHD Seal Verified: ❑ Yes E] No <br />Drilling Company: �1P,Q ��- ►A <br />Screen Length <br />From: <br />To: <br />Driller Onsite: se" <br />METHOD USED <br />Cement 941b <br />Bags <br />Consultant: tA�� bro t.) �L-- Filter Pack <br />From: <br />To: <br />Bentonite <br />Geologist: <br />From: <br />To: <br />Grout <br />From: <br />To: <br />Public Water System Onsite: ❑ Yes VNo <br />Domestic Well Onsite: /Yes ❑No <br />If yes, location and distance: `� 00 <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />i <br />GROUTING or DESTRUCTION Total Depth: Sb <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation <br />❑Well Destruction <br />El Boring Installation <br />L Boring Destruction <br />METHOD USED <br />Cement 941b <br />Bags <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity 4Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />fRall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br /># gs <br />Thickest Thinnest <br />#f Bags <br />2.5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />160 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />1 ' 70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />1 80 <br />8 <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height . <br />ABOVE-: ACUND Clsrr aax <br />Co&FiF-TTON cOWLE 7c.N <br />Cr and 3urfaca <br />proof <br />ft. <br />f�. <br />w <br />Kr C <br />" o <br />siattad y3 � _ <br />sac;ion "� = <br />67svW Pack <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank 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 />Screen Feet <br />Bentonite/Gement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.821 4.7 <br />i <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />