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SANJOAQUINEnvironmental Health Department <br /> VKw`� :L. <br /> '�k�- --•COUNTY <br /> Crreo'tness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 9'Ahb57 Inspector:�``'"'d �""� CONSTRUCTION <br /> Facility Address; Lo—'Z, GA3 i Sj c" <br /> Well Address: .•JJ Total Depth: <br /> WP# Lltt Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes El No <br /> Drilling Company:Driller Onsite: Screen Length From; To: <br /> Consultant: S � �" Filter Pack From: To; <br /> Geologist: < j v+� 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 easIng <br /> If yes,location and distance! �`��'� <br /> SAMPLINGs»v .>; fluNn <br /> r�►s�sr-sox ' <br /> Holding Temperature: cnWLErfiaN FLETON GOM <br /> Method: Grovnas�.a"taaa <br /> Screening Method: pran <br /> Verified Chain of Custody: ❑Yes ❑No ' <br /> SPOILS % <br /> Contamination Noted: ❑Yes ❑No m <br /> If yes,spoils storage Location: _ . Q <br /> ntatta�i �•s ,.,,., <br /> gssaon ' F i* � <br /> Covered: ❑Yes ❑No _ <br /> If yes,material: (j _ <br /> GROUTING.or-DESTRUCTION-Total Depth: '-••! f .-_= ­-. -• <br /> Depth to Water: <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation dell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill Filter Pack Type/Size: <br /> ❑ Gravity *Tremie WOther: � �' Type of Method: <br /> Water Cement 471b Water cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest ilBags Thickest&Thinnest 4Bags 9 onto nitelCement Mix 3% Mix 5% Mix <br /> 2,5 5 1 5 1 Dentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 3 <br /> 1 20 4 20 0 4 ® L~ <br /> 12. 5 <br /> 5 25 5 25 0 $ %9 <br /> 1S 30 6 3o 60 6 '/ <br /> 17.5 35 7 35 70 7 p <br /> 20 qd o 40 80 8 ` 7 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 96205 T 209 468-3420 1 F 209 464-0138.1 www.sicehd.com <br />