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Environmental Health Department <br /> f�ci`zL —COUNTY— <br /> ?� Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: NLOlfo Inspector: CONSTRUCTION <br /> Facility Address: "L <br /> Well Address: Total Depth: <br /> WP#_� 'e 'L b�'��,rl- Well#: Drilling Rig Type: <br /> Soil Boring#: G,�,]l - <br /> Drilling Company: E� C�Q�ir� Min 2"Annular EHD Seal Verified: El Yes ElNo <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: fir. �� �,; Filter Pack From: To: <br /> Geologist: �h�ojE� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: W— T <br /> height <br /> SAMPLING ABVE-GROUND <br /> Holding Temperature: COWPLETION ccoMP�_LEnON <br /> Method: Grwnd Sudaas <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No - —n• <br /> tt. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No _— <br /> If yes, spoils storage Location: ' = 0 <br /> 0 <br /> slotted _ <br /> I <br /> sacJon xa <br /> Covered: ❑ Yes El No Pack <br /> if If yes, material: - <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: Z.S n• — tt- <br /> Grout Material: N MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> ` Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Over Drill Filter Pack Type/Size: <br /> ❑ Gravity E/Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bags gallIllons Bags <br /> Thickest Thi est qags Thickest Thinnest uBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1. 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 1 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 1 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 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />