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I?Y'- " SAN10A Q UIN <br /> -` Environmental Health Department <br /> Cir•eutness grows here. <br /> c/ Monitoring Well/Soil Boring Inspection Report <br /> Date: 15 Z Inspector: 10k" CONSTRUCTION <br /> �l <br /> Facility Address: W q- i� nl/R51 CV0111 <br /> Well Addres : Total Depth: <br /> WP# 0 Z' Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: (/�.S &T( <br /> Filter Pack From: To: <br /> Geologist: Jo -.qBentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT height <br /> SAMPLING A VE-GROUND <br /> Holding Temperature: COMPLETION COMPL=riON <br /> Method: <br /> Screening Method: orout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> ft. _ <br /> SPOILS <br /> 0 <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes,spoils storage Location: at�n�d = — - <br /> sscacn = <br /> Covered: ❑ Yes ❑No <br /> _ g­w Pack <br /> If yes, material: C4 9 JC �,,� 3 Z/ EE <br /> — <br /> GROUTING or-DESTRUCTION Total Depth:- - be-�a✓C 0� <br /> Depth to Water: IZ-0 M n' <br /> Grout Material: 224g& ce-0 e-2` <br /> Gallons of Grout Used: ,So ftA4 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> El Pressure Grout ver Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity *XfTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas allons Bags <br /> Thickest Thinnest 41 Bags T1JJ'.e t l'hinn�st Fags SentonitelCernent Mix I°l° TV1jX <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12,5 25 5 25 5o 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />