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uip <br /> N10"o Z SANAOAQUII� <br /> Environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: A CONSTRUCTION <br /> Facility Address: 2-100 �^- <br /> Well Address: Total Depth: <br /> WP# Gb 401G2 Well#: 0S!n7__a Drilling Rig Type: <br /> Soil Boring#: <br /> Company: .,.K� ,�i•�c.y Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling p y: wo't <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: O Filter Pack From: To: <br /> Geologist: �r Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLEr10N cccmPPLEnoN <br /> Method: Ground Surface T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —`--n' <br /> tt. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> C <br /> If yes, spoils storage Location: ebnad = . <br /> eec.on — B <br /> Covered: ❑ Yes ❑No = aa�+a..k <br /> If yes, material: ='x <br /> GROUTING or DESTRUCTION Total Depth:_ <br /> Depth to Water: 3• tt. tt <br /> Grout Material: Ally ee-4 <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation g Slot Size: <br /> CaBorin Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout x6ver Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> a r Ce 4 Water Cement 941b <br /> s Ba s gallons Bags <br /> Thickest Thinnest Bags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 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 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> Zy ,4`6M4- Iry �v M, v U.*Jf 10/16/2017 <br /> col' <br /> 1868 E. Hi lton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />