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oorb . <br /> 5 A N Environmental Health Department <br /> ire <br /> tRJ • <br /> , r `E " � COUNTY <br /> Greatness grows here . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : Vl � Z� Inspector : (ot,.�,' 1 � -I, CONSTRUCTION <br /> Facility Address : Ik, ., , � s, �� t_ k ►�o � Ak A rte' <br /> Well Address : Total Depth : <br /> WP # �j Well # : Drilling Rig Type : <br /> Soil Boring# : <br /> Drilling Company : 6(� ca4 <br /> Min 2 " Annular EHD Seal Verified : ❑ Yes 11 No <br /> Driller Onsite : Screen Length From : To . <br /> Filter Pack From : To : <br /> Consultant : �g 'O L� �d; ; rQliLuL�iti, C \ <br /> Geologist : Bentonite From : To : <br /> Grout From : To : <br /> Public Water System Onsite : ❑ Yes El No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes ❑ No casing <br /> If yes , location and distance : height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature : COMPLETION COMPLEnON <br /> Method : <br /> t;=r*4 Sudws <br /> Screening Method : nr«n <br /> Verified Chain of Custody : ❑ Yes ❑ No n' <br /> tt. <br /> #t. <br /> SPOILS A '— <br /> Contamination Noted : ❑ Yes ❑ No se a = <br /> , <br /> If yes , spoils storage Location : �� Ole <br /> = o <br /> tbttsd <br /> sac;ion — <br /> Covered : ❑ Yes ❑ No grxviW pack <br /> � <br /> If yes , material : <br /> GROUTING or DESTRUCTION Total Depth : ., <br /> Depth to Water : V%J { --------tt- �` ff- <br /> Grout Material : MATERIALS/ DEVELOPMENT <br /> Gallons of Grout Used : <br /> Casing Type : <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> El Boring <br /> Size : <br /> Boring Installation IN Boring Destruction Bags Size : <br /> Cement : <br /> METHOD USED Bags Sand /Gravel : <br /> Type/ Brand of Bentonite : <br /> El Pressure Grout ❑ Over Drill Filter Pack Type/Size : <br /> V1Gravity ❑ Tremie ❑ Other : Type of Method : <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rail ons Bags <br /> hhhhh <br /> Thickest Thinnest # Bags Thickest Thinnest # Bags Bentonite/Cement Mix 3 % MIX 5 % MIK <br /> 2. 5 5 1 5 10 1 Bentonite per 47 Ib 1 .41 2A7 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2082 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 /> 4f/ 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 />