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�Ar{ �'.� �AQ� <br />COUNTY <br />Grea:ntss yrv�r�~ hare. <br />Environmental Health bep�artment <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Ins ector: � � %� 1 � CONSTRUCTION <br />Facility Address: � � < < M �'� �� <br />Well Address: T <br />WP#_�C� �{ 3 �S Well#: <br />Soil Boring#: <br />Drilling Company: CG� S � -�_ <br />Driller Onsite: <br />Consultant: � � L°� <br />Geologist: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />�pnll � <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />GROUTING or DESTRUI <br />Depth to Water:--� <br />Grout Material: I' <br />Gallons of Grout Used: <br />- '� Total Depth: <br />�` � ��rilling Rig Type: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />ON Total Depth: <br />yin � <br />•'� <br />�� <br />❑Well Installation ell Des->:ruct�'or, <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />�l Gravity Tremie ❑Other: <br />�J <br />Tater <br />oallons <br />Cement 47ib <br />Bags <br />�°�° Ititix <br />Vater <br />gallons <br />Cement 941h <br />Bags <br />Thickest <br />Thinnest <br />� 6ags <br />Thickest <br />Thinnest <br />„Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />I 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 />� <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />50 <br />5 <br />17.5 <br />35 <br />7 <br />3S <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />$ <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />To: <br />To: <br />To: <br />To: <br />COMPLETION ❑Stove Pipe ❑Christie Box <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 <br />Feet <br />10/16/2017 <br />18&8 E. Hazeifion Avenue J Stockton, California 95205 J T 205 468-3�i20 (E 209 464-0138 J vwvw.sicehd.com <br />den#Qnitel�ement tulix <br />�°�° Ititix <br />�°�° Iuli� <br />Bentonite per �� Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />18&8 E. Hazeifion Avenue J Stockton, California 95205 J T 205 468-3�i20 (E 209 464-0138 J vwvw.sicehd.com <br />