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,�:� - =°- � A IV�j10A U I N <br />'" COUNTY <br />. GI"::CILt1�'SS a��t^rs r�crr�. <br />Environmental Health Department <br />Monitorin Well/Soil Boring Inspection Report <br />Date:�����--�l.�—Inspector: CONSTRUCTION <br />Facility Address: '� `� <br />Well Address: �J � <br />WP# Vi'S�L� Well#: <br />Soil Boring#: <br />Drilling Company: 'CS�� ��� <br />Driller Onsite:y�l-� `�' <br />Consultant: —qtr-�-�,P��� � <br />Geologist: � �y� �- �� <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 />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />,�. <br />❑ Yes <br />❑ Yes <br />❑Yes <br />❑Yes <br />Total Depth: <br />Drilling Rig Type: <br />� Min 2" Annular EHD Seal Verified: <br />11 <br />■ • <br />❑No <br />❑No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth: <br />1 <br />Depth to Water: � 5� <br />Grout Material: ,�7 CtiP� �-�- � <br />Gallons of Grout Used: � 2���0� <br />❑Well Installation ❑Well Destruction <br />��� <br />❑Boring Installation �lBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity C�1Tremie <br />Vti+ater Cement 471b <br />gallons Ba s <br />Thickest Thinnest #Bags <br />2.5 5 1 <br />5 2 <br />7,5 15 3 <br />10 20 � <br />12.5 25 5 <br />15 30 6 <br />17.5 35 7 <br />20 40 S <br />❑Other: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />❑ Yes ❑ No <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />❑ Stove Pipe ❑Christie Box <br />casing . <br />height <br />�o�-��out�ty c�-�isr�t-aa�c <br />COi�5PLE7�vN C�3i�riptETtcN <br />Grsxic�d ��-facs �.-rte.-=--�--�...�, <br />Q�«.Tt <br />„�...� fl. <br />ft. <br />:�� �— <br />a <br />_.. <br />p' <br />'�: G <br />- _ �, <br />sac:;on �:: <br />.� <br />�, piv�i nags <br />:�:: <br />�. — <br />=--. _. _ <br />� -w = it. <br />.� <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 />gentonitefOement Nli�t <br />3°�° (ulix <br />�°I° IUli�c <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per �4 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 F 209 464-0138 � www.sicehd.com <br />