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.."!,i�S�-... —COUNTY— <br />��;;r'�. ` Greotnass grows here <br />Environmental Health Department <br />9 � Mo(n�itoring Well/Soil Boring Inspection Report <br />Date: '9�`'/ Z2' Inspector: V� CONSTRUCTION <br />Facility Address: T 06 N� Sr~ C✓ Y`r t t1G✓ <br />Well Address: it Total Depth: <br />WP# SS"L \Nell#: Drilling Rig Type: <br />Soil Boring#: �P _� � � Min 2" Annular EHD Seal Verified: <br />Drilling Company: /'nrrt tt' (..2�tr Ge, <br />❑ Yes ❑No <br />Driller Onsite: Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: �. � e Bentonite Fram: To: <br />Grout From: To: <br />Public Water System Onsite: ❑Yes ❑No COMPLETION ❑Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑Yes ❑ No <br />SPOILS <br />Contamination Noted: ❑Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑Yes ❑No <br />If yes, material: /� <br />GROUTING or DESTRUCTION Total Depth: S � / <br />Depth to Water: � Zf� <br />Grout Material: Q /t�'�-� <br />Gallons of Grout Used: � S� __ O � <br />❑Welllnstallation �IeFDestruction �) <br />❑Boring Installation ❑Boring Destruction Vo I �? <br />METHOD USED <br />❑Pressure Grout.�,,❑Over Drill <br />❑Gravity y�lremie ❑Other: <br />Water <br />allonz <br />Cement 471b <br />ea <br />Water <br />allons <br />Cement 941b <br />ea <br />Thickest <br />Thinnest <br />kBags <br />ThicF;est <br />Thinnest <br />Faags <br />zs <br />s <br />1 <br />s <br />l0 <br />1 <br />s <br />to <br />z <br />to <br />zo <br />z <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />ZO <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 />4D <br />0 <br />40 <br />DO <br />8 <br />�. <br />,l <br />\\V) <br />_Tl. <br />ssc5on <br />tt. <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 Feet <br />BentonitelCementMlx <br />3 % Mix <br />5%Mix <br />Benioniteper471b <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 i www.sicehd.com <br />