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ppViN� <br /> S A AQU I k Environmental Health Department <br /> —COUNTY— <br /> F <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �1-17i Insp ctor: Wl " CONSTRUCTION /I L <br /> Facility Add ress: -L�'�R i:'2R q=Qe <br /> Well Address: 's cwW-L �— Total Depth: <br /> WP# 00 3 5 SI Z Well#: Drilling Rig Type: Ire YI <br /> Soil Boring#: tots, Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: rQ(Z1£ <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: !IC-, 6 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 ONO casing <br /> If yes,location and distance: height <br /> Rj— <br /> SAMPLING Aaove.cROUND <br /> COWLETION l'.COMPLETION <br /> Holding Temperature: cornrLeTioN <br /> Method: around solace T <br /> Screening Method: grout <br /> 0 n <br /> Verified Chain of Custody: ❑Yes ❑No n— . St �P <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: 4wrod <br /> 44cibn _ <br /> Covered: ❑ Yes ❑No <br /> If yes, material: a \ B <br /> GROUTING or DESTRUCTION Total De hx lL? C2n2o /) <br /> Depth to Water: tt• — �tt <br /> Grout Material: t S a <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,�Moring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over 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 /> allons Bags gallons Bags <br /> Thickes Thinnest #Ba s Thickest Thinnest kBegs Bentonite/Cement Mix 3% MIX 5%MIX <br /> rAl 2.5 s 1 s 10 1 Bentonite er471b 1.41 2.47 <br /> 5 10 10 20 2 1 Bentonite per 94 lb 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 s0 5 <br /> 15 30 6 30 6o 6- <br /> ITS 35 7 35 70 7 <br /> 20 40 B 40 so e <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 />