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NSA Nsd OAQ U i Environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:/2-f3-li Inspector: A 0**'4� CONSTRUCTION <br /> Facility Address: 2700 w• b&SI""0 4=,.^' <br /> Well Address: Total Depth: <br /> WP# C6 your/ Well#: 4S-2-4; OS-2-1 Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: weo.�wnr rL Or.'G6�'�+� Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> �ys Screen Length From: To: <br /> Driller Onsite: CA Filter Pack From: <br /> Consultant: <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 casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GRouND <br /> Holding Temperature: COWLEMN CCMPLEn0N <br /> Method: G=ndSurf=* + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> ft. <br /> SPOILS <br /> o <br /> Contamination Noted: ❑ Yes ❑No =` <br /> If yes, spoils storage Location: stortad <br /> s�c4on <br /> Covered: ❑ Yes El No <br /> g-viW pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: Zai Z6 <br /> Depth to Water: 3� tt• n' <br /> Grout Material: /►�•��"^""� <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Goring Destruction gags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout LJOver Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall s Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 9Bags 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 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> f� �+�s ,,��r .�., �ia�q�!/r,•.f/y6. Ply tcs �'d ..+�X .ima•'wu� 106— da-99 vf-W 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 />