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FCM1'W C•" <br /> SANJ0A0UIN, Environmet,.dl Health Department <br /> '• t-i`I :_� `I —COUNTY— <br /> "ic:rre�':`•` Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: � °�i Inspector: `�> CONSTRUCTION <br /> � <br /> Facility Address: F kt0kP <br /> Well Address: r Total Depth: <br /> WP# U\X) Well#:C3�z4[1 Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ONO <br /> Drilling Company: CO 5cR9 <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: C L Filter Pack From: To: <br /> Bentonite From: To: <br /> Geologist: � p Grout From: To: <br /> Public Water System Onsite: t!1 Yes ❑No COMPLETION El stove Pipe ❑Christie Box <br /> Domestic Well Onsite: U❑ Yes ]N0 casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND C*181SW43Ox <br /> Holding Temperature: COWLETION COMPLETioN <br /> Method: Ground$'''1"'—T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ONO 4r <br /> n. <br /> SPOILS ' <br /> Contamination Noted: ❑Yes 0 st° - <br /> 4 spoils storage Location: huS�<ki Storied { =_ <br /> se`e'Jan ?a <br /> Covered: Yes ONO g(, N <br /> Pack <br /> If yes, material: �Ql�cl_ PQ <br /> GROUTING orrDESTRUCTION�Total Depth:\Nck S !. <br /> Depth to Water: 'z)p Wes! ft n' <br /> Grout Material: �Ik4k� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: A k <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 /> ❑Pressure Grout Dover Drill Type/Brand Bentonite: <br /> `� Filter Pack Type/Size: <br /> e/Size: <br /> ❑ Gravity ITremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 94lb <br /> allons Bags gallons Bags <br /> Thickest Thinnest $Bags Thickest Thinnest $Bags Bentonite/Cement Mix 3%Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per47lb 1 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 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 /> 175 5 35 70 7 <br /> 20 40 8 1 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 />