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PDUIry' _,� <br /> Health Department <br /> SKJOAQUIN Environmental <br /> a `' —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I Inspector:Jr ,x t CONSTRUCTION <br /> Facility Address: 15 C '1 1.tolbow Q <br /> Well Address: Total Depth: <br /> WP# Well#:1e(.__ Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: O ri 9. na. Min 2"Annular EHD Seal Verified: ❑Yes ONO <br /> Screen Length From: To: <br /> Consultant: <br /> :1 l�.atce 'fovvt.r Filter Pack From: To: <br /> Consultant: I�..,.a ira,r1 �Ct.rrvvw"� r.1a{h.-..,^ <br /> Geologist: Bentonite From: To: <br /> �wvt�v s na✓L� /� SA <br /> A_ <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes []No Y easing <br /> If yes,location and distance: -� height <br /> SAMPLING AsoGvecpotlraoaox <br /> Holding Temperature: COWLE710N CCr,IPLEnON <br /> Method: G=nd sunaa+ <br /> Screening Method: grout <br /> Verified Chain of Custody: ElYes ❑Non' <br /> _n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ONO ° = <br /> If yes,spoils storage Location: alarm s� _ 3 <br /> aac:'on M1i <br /> Covered: ❑ Yes ONO = gmw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: tt. IF <br /> Grout Material: r1Ga,' Cava MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> // Casing Type: <br /> ❑Well Installation RO ell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED �� Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout L�SOver Drill <br /> � � Filter Pack Type/Size: <br /> El Gravity Llrremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> allons Bags 2allons Bags _ <br /> Thickest Thinnest NBags Thickest Thinnest #Bags -[Bentonite/Cement Mix 3%MIX 3%MIX_ <br /> 2.5 5 1 K4O <br /> 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 30 3 - 1 <br /> 1. 20 4 40 4 <br /> 12.5 25 5 50 5 <br /> 15 30 6 60 6 <br /> 17.5 35 7 70 7 <br /> 20 40 B so B <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />