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—COUNTY— <br />'cScrpoty0',:"'� Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: jl S(LZ Inspector: �J �'�S %� h CONSTRUCTION <br />Facility Address: iiool MG'�1'�G V�6�• �u�.� S1toCkODk'? <br />Well Address: V Total Depth: <br />WP# CUU `I L.� Well#: Drilling Rig Type: <br />Soil Boring#: Min 2" Annular EHD Seal Verified: <br />Drilling Company: H C71I In /')-� �-- <br />❑ Yes ❑ No <br />Driller Onsite: Z <br />Screen Length <br />From: <br />To: <br />Consultant: <br />Filter Pack <br />From: <br />To: <br />Geologist: <br />Bentonite <br />From: <br />To: <br />10 20 <br />Grout <br />From: <br />To: <br />Public Water System Onsite: <br />❑ Yes []No COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />cpnil C, <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 9'l/ <br />Depth to Water: <br />Grout Material: U%( <br />Gallons of Grout Used: Z/U <br />❑Well Installation Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity Tremie ❑Other: <br />Water <br />alions <br />Cement 471b <br />Bas <br />Water <br />allons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />2.5 5 <br />itsags <br />1 <br />Thickest Thinnest <br />5 10 <br />#Bags <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12,5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <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 1.41-1 2.47 <br />Bentonite per 94 Ib 2.821 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />