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I <br />��°!'.� `1 —COUNTY-- <br />�� � Grentn..: grows he, e. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: I 2 Inspect{o`}r: � • � J� i r1(a�;, CONSTRUCTION <br />Facility Address: �i''�C) � � VY�. l�V�itn Lu��'>QI� �/t`tt� <br />Well Address: i3(,` Total Depth: <br />WP# OD�'i 4�"�� Well#: Drilling Rig Type: <br />Soil Boring#: `..��t `�L �'5�;�,�°d'7c$ �SI'v� <br />-r- ; Min 2" Annular EHD Seal Verified: <br />DrfllingCompany: F� JYZVlt,Pt� (�il't" �"'y7� <br />❑ Yes ❑No <br />1 Screen Length From: To: <br />Driller Onsite: _Filter Pack From: To: <br />Consultant: '� tGQ( 7�'f`, <br />Geologist: � \7(�t�. � Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑Yes ❑No COMPLETION ❑Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑Yes ❑No � aaeing <br />If yes, location and distance: _-����� height T. <br />SAMPLING ABOVEGROUND T <br />COh�LETION OHRISTY•BOX <br />Holding Temperature: cornPLerioN <br />Method: om,nd salac. '�—'—'— <br />Screening Method: er«� <br />Verified Chain of Custody: ❑Yes ❑No �ft <br />—n. _ <br />n. <br />SPOILS � _ <br />�; = ;' m <br />Contamination Noted: ❑Yes ❑No r° = " <br />If yes, spoils storage Location: �Icnod 'r��'� = s <br />�actlon k`j _ .8 <br />Covered: ❑Yes ❑No � _ ��� <br />If yes, material: = '.. <br />GROUTING or DESTRUCTION Total Depth: ��j 2�2bj 2t�j 2��,� � <br />Depth to Water: � i} INA"`LI' f�`�����"v ft. � n' <br />Grout Material: �ttl' <br />Gallons of Grout Used: 106'L � f',, MATERIALS/DEVELOPMENT <br />�6 � � � � ��i�� Casing Type: <br />❑Well Installation ❑Well Destruction IJ Blank Feet Screen Feet <br />❑Boring Installation i�lBoring Destruction Slot Size: <br />Bags of Cement: <br />METHOD USED Bags Sand/Gravel: <br />❑Pressure Grout ❑Over Drill Type/Brand of Bentonite; <br />Filter Pack Type/Size: <br />,I�Gravity ❑Trerpie ❑Other: Type of Method; <br />,,. <br />Water <br />allons <br />ement 471b <br />Bas <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />'�-�--M9a�� <br />Thickest <br />Thinnest <br />77 Bags <br />zs <br />s <br />1 <br />s <br />l0 <br />1 <br />s <br />l0 <br />2 <br />l0 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />30 <br />20 <br />0 <br />10 <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 />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />B <br />40 <br />80 <br />8 <br />BentonitelCement Mix <br />3 % Mix <br />5 % Mix <br />Bentonite er 47 Ib <br />1.41 <br />2.47 <br />Bentonite er 94 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 e T 209 468-3420 I F 209 464-0138 � www.sicehd.conT <br />