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SQN -JOQQU IN Environmen' iI Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: S Z "2�2\ Inspector: CONSTRUCTION <br /> Facility Address: 1 SbH Sf <br /> Well Address: ety- SA-^-I A-L A-6o Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: UZA Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller Onsite: (c, <br /> Consultant:��L Filter Pack From: To: <br /> Bentonite From: To: <br /> Geologist: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes C No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: Yes ❑No casing <br /> If yes, location and distance: —s height <br /> _VWT <br /> SAMPLING N (VA ABOVE-GROUND C}-mmw-BOX <br /> Holding Temperature: COMPLEr)ON cOM LEMN <br /> Method: Ground Suixs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No _ft. <br /> ft. <br /> f!. <br /> SPOILS <br /> Contamination Noted: ❑ Yes IIN0 <br /> If yes,spoils storage Location: slotted <br /> sac on "— <br /> Covered: f7 Yes ❑No ' <br /> If yes, material: Cpy (AK,) -`rkrlp_' �— �� __ <br /> GROUTING or DESTRUCTION Total Depth: IF <br /> g� —' <br /> Depth to Water: &5 % ft <br /> Grout Material: ^S <br /> Gallons of Grout Used: v� 5 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation gWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑B Slot Size: <br /> oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout 00verDrill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity �Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> allons Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 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 5 7 35 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 />