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�f ' -b-\ 5ANADAQUIN <br /> (( Environmental Health Department <br /> I".ED1 :-� —COUNTY— p <br /> i-�i�yr. Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �Z Z�'L3 Inspector: v1 CONSTRUCTION <br /> Facility Address: 116MID CWS <br /> Well Address: Total Depth: <br /> WP# Q_04 6 Well#: Drilling Rig Type: <br /> Soil Boring#: V%A W Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: Screen Length From: To: <br /> ConsultCant:ant:Driller : �Y Filter Pack From: To: <br /> FiV,� <br /> Geologist: Mp( af1 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No aasiag <br /> If yes,location and distance: height '. <br /> SAMPLING pgpyp.GpqUNp <br /> CNFi I�O <br /> Holding Temperature: CO OLfiT1ON ooMr1>PLETrioN <br /> Method: <br /> Screening Method: 8ro� <br /> Verified chain of Custody: ❑Yes ❑Noft <br /> SPOILS = ,; <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: At' .2 <br /> sac9on 'S <br /> Covered: ❑Yes ❑No P _ ar+VWaa* <br /> If yes,material: <br /> GROUTING-or-DESTRUCTION•Total Depth: -' .• <br /> Depth to Water: ft. <br /> Grout Material:::� t MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation MWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring 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 I�j7emie ❑Other: Type of Method: <br /> Water Cement 471b Water Cemant941b <br /> ailons Bees allons Bags <br /> Thickest Thinnest ABags Thickest Thinnest haags BentonitelCement Mix 3%Mix 5%Mix <br /> 2.5 s 1 s 10 1 Bentonite er 471b1 1.411 2.47_ <br /> s 10 2 10 20 2 Bentonite er 94 lb 2.82 4.7 <br /> 7.5 15 8 15 20 a <br /> 10 20 4 20 40 4 <br /> 1215 25 d 5 25 50 5 77 <br /> 15 80 6 so 60 • 6 GL <br /> 1715 85 7 95 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 />