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—COUNTY— AL. . . _.! . — � L. Zp�.w.:� <br /> --reatness grams here. <br /> Monit,, ing Well/Soil Boring Inspectic. .teport <br /> Date: in, Inspector: L CONSTRUCTION z <br /> Facility Address: 'Jo0 vri�4 <br /> Well Address: Lou & Ps44,&u.,L- 5'44- Sa- Total Depth: <br /> wp#MQ31 D25-- Well#: P �2 q j Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: „ Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: B klw Screen Length From: To: <br /> Consultant: A41*1..' Filter Pack From: To: <br /> Geologist: ��{ Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No <br /> z:asing <br /> If yes, location and distance: height <br /> SAMPLING ABMS-GROOM i3 <br /> Holding Temperature: CQ.PPLErFON C MPLETiom <br /> Method: Gmind S"rfa= <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No - <br /> it. <br /> #t. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No = e <br /> If yes, spoils storage Location: :ter <br /> Covered: ❑Yes ❑No 'w = S-­tPad- <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:? �'�S• <br /> Depth to Water: tl ' <br /> Grout Material: 0,A Ct-4.,-'45- MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:" <br /> Casing Type: <br /> ❑Well Installationell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> FeWressure Grout Dover Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 941b <br /> gallons Bas Ralill ons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% Mix <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 941b 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 50 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' 209468-34201 IF 209464-0138 I www.sicehd.com <br />