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y�,�c�� SA Ns1 UA(�U I N Environmental Health Department <br /> —COUNTY <br /> °�G..'01 Greatness grows <br /> // Monitoring Well/Soil Boring Inspection Report <br /> Date:3��/ZL Inspector: CONSTRUCTION <br /> Facility Address: ZCE'l <br /> Well Address: Total Depth: <br /> W P# t_/C.? '/ -7- 7 Well#: Drilling Rig Type: <br /> Soil Boring#: f3., y_ 9- -3 Min 2" Annular EHD Seal Verified: EJ Yes El No <br /> Drilling Company: /l�o�--e ���ki.,s.,.� Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: /12-ea,c <br /> Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING /ABOVE-GROUND <br /> Holding Temperature: COhPLErJON CoMP�LEnON <br /> Method: Ground Surface <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes El No -�—n• <br /> it. <br /> ts. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stoned <br /> soon <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: IF <br /> Depth to Water: — n• <br /> Grout Material: ,�('F<<,j ('�:�,..�' <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> ❑Boring Installation 2413oring Destruction Bags Slot Siziz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> El Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ® cavity ❑Tremie ❑Other: Type of Method: <br /> -rlkZ ;4i/ <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags 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 <br /> 10 20 4 20 40 4 <br /> 12.5 1 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 1 40 8 40 80 8 <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 />