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SANsdDAQUIN►►-s�i '_ �� COUNTY Environmental Health Department <br /> GI-e -fness grows here. <br /> Monitoring Well/Soil Boring p P Inspection Report <br /> Date: Y*J Z3 inspector: tin k CONSTRUCTION <br /> Facility Address: Ve, <br /> Well Address: Total Depth: <br /> WP#jj0g6054 Well#: Drilling Rig Type: <br /> Soil Boring#:Drilling Company: Min 2" Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant "' 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 ❑No as-sing <br /> If yes, location and distance: h� -get <br /> SAMPLING ABbVPdjROUND CHR sax <br /> Holding Temperature: � ��,1PiL7�sJT1 <br /> Method: "" ^ <br /> Screening Method: grovi <br /> Verified Chain of Custody: ❑ Yes ❑No - <br /> -fit. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> ig �-- <br /> If yes, spoils storage Location: :=r <br /> .atcno F T <br /> aan <br /> Covered: ❑ Yes El No <br /> If yes, material: _ <br /> GROUTING-or-DESTRUCTION. Total Depth:-- &&.. <br /> Depth to Water: ' <br /> Grout Material: .N� L��C u"A MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation KWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring�D\estruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> 5 Type/Brand of Bentonite: <br /> X'ressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity rgrT 'e ❑Other: Type of Method: <br /> Water CVnent 47 Water Cement Mlb <br /> gall Bags r gallons Bags <br /> Thickest Thinnest Thickest Thinnest Bags Benton itelCe ment Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1 .41 2.47 <br /> 5 10 z 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7 55 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 /> 17.5 35 7 35 70 7 <br /> za 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 />