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IN <br /> (� SAQ COUNTY- Environmental Health Department <br /> c,caa?•f Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector:S•�gh1f1')GIV�i<'1G�G CONSTRUCTION <br /> Facility Address: 1010 (011 N. huhler Ageet,SftIcKUr <br /> Well Address: Total Depth: <br /> WP# ZS���(5°/ Well#: MW 13 Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: 4 AAer)6e Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: �U'l V11 p Screen Length From: To: <br /> Consultant: {�}}I�f Filter Pack From: To: <br /> Geologist: 3phy) 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 ❑No <br /> casing <br /> If yes, location and distance: height <br /> SAMPLING _ <br /> ABOVE-GROUND <br /> Holding Temperature: COWLETION COOMP�LEnoN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No -�---n <br /> tt. <br /> ft. <br /> SPOILS <br /> a <br /> Contamination Noted: ❑ Yes El No = r <br /> If yes,spoils storage Location: slotted <br /> .on — <br /> Covered: ❑ Yes ❑No = gr,,ol Pack <br /> If yes, material: s <br /> GROUTING or DESTRUCTION Total Depth: W� FJ =_ <br /> Depth to Water: <br /> Grout Material: Neat commf <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation [Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> El Pressure Grout )(ever Drill C1 (/�U�e <br /> Filter Pack Type/Size: <br /> ❑ Gravity )�Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall Bags allons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest NBags 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 10 2 10 20 2 Bentonite per 94 lb 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 3S 7 3S 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 />