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"= COUP <br />T Y <br />hei <br />M nito ing Well/Soil Boring Inspection Report <br />Date; I Inspector. <br />Facility Address: <br />Well Address: r� <br />WP# y 'L_u �, Well e <br />Drilling Company: `LN <br />Driller Onsite: W e -S <br />Consultant: \A�\ <br />Geologist: 1 \4Nw <br />Public Water System Onsite: V1 Yes ❑No <br />i <br />Domestic Well Onsite: ❑ Yes INo <br />If yes, location and distance: <br />SAMPLING tJ/NX <br />Holding Temperature: <br />Method: <br />Screening Method.– <br />%=I e <br />ethod:_ <br />erified 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 />i <br />GROUTING or DESTRUCTION Total Depth:_ <br />Depth to Water:_ 1\/ /A <br />Grout Material: <br />Gallons of Grout Used. t^A 15 lija <br />❑We11 Installation <br />Well Destruction <br />]Boring <br />Installation ]Boring Destruction <br />❑Pressure Grout I�Over Drill <br />[�] Gravity ❑Tremie ❑Other: <br />Yater Cement 471b <br />ailons Ba s <br />Thickest "Thnnest#1,1;,,gs <br />2.5 <br />5 7.5 1D 12, 5 15 17.5 2D <br />'water <br />Cement 94 )b <br />CONSTRUCTION /V//, <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: <br />Screen Length <br />Fitter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />�asi�g <br />� i.�ic'N <br />end SudaCg <br />grout <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑ Christie Box <br />.__– <br />MATERIALS/DEVELC�PMEi1iT /(%j� <br />Casing Type: <br />Blank Feet Screen <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 />Feet <br />ThickQst Thinnest #Bags _ l�enit�ni�efC~emen� i�li3� �°�o i�l� �°�n �iix <br />5 1Il i Bent�nif� per 4'� Ib 1.x'1 �,�,� <br />lD 20 2 Bentonite per 94 lb <br />15 30 2.82 4.7 <br />3 <br />2© 40 4 _ <br />35 1 70 7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � vwvw.sicehd.com <br />ral:liir-u <br />-N ,_ <br />4 <br />Ori <br />�r <br />�� <br />— <br />.__– <br />MATERIALS/DEVELC�PMEi1iT /(%j� <br />Casing Type: <br />Blank Feet Screen <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 />Feet <br />ThickQst Thinnest #Bags _ l�enit�ni�efC~emen� i�li3� �°�o i�l� �°�n �iix <br />5 1Il i Bent�nif� per 4'� Ib 1.x'1 �,�,� <br />lD 20 2 Bentonite per 94 lb <br />15 30 2.82 4.7 <br />3 <br />2© 40 4 _ <br />35 1 70 7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � vwvw.sicehd.com <br />