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S Q N J O QQ U I N Environmental Health Department <br /> —COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: L Inspector: 111C�vk CONSTRUCTION <br /> Facility Address: E LV• G S� <br /> Well Address: k& i( /?�O`tiotal Depth: <br /> WP# Well#: r . r Drilling Rig Type: <br /> Soil Boring#: Ltt- Lq Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller Onsite: "So r l <br /> p,�r t al, Filter Pack From: To: <br /> Consultant: <br /> Geologist: �a-� i Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes eNo COMPLETION ❑ Stove Pipe []Christie Box <br /> S <br /> Domestic Well Onsite: ❑ Yes '❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND C4iR1M430X <br /> Holding Temperature: COMPLETION COMPLEMN <br /> Method: aramd surlx. <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No h, <br /> SPOILS <br /> Contamination Noted: ❑ Yes ZNo <br /> If yes, spoils storage Location: <br /> slotted � <br /> aac4on — <br /> Covered: El Yes ❑No 9 vi ck <br /> p- <br /> a <br /> If yes, material: : FEE <br /> GROUTING or DESTRUCTION Total Depth: MX­- <br /> Depth to Water: A t �° �� <br /> Grout Material: 0 1IJ 'I'll l MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: (7 "tZ <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation/613oring Destruction 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 QTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags allons Ba s <br /> Thtckest Thinnest taa Thickest Thinnest Bags 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 io 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 1 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 /> 464-0138 www.sicehd.com <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468 3420 1 F 209 � I <br />