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° #°C_ SWAM M I N <br /> N � _ Environmental Health Department <br /> —COUNTY <br /> — <br /> Greatness Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1 2C + cl Inspector: S�kCONSTRUCTION <br /> Facility Address G Z W <br /> Well Address:� Total Depth: <br /> WP# "t lV ( - Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: ri)-nw-Vlt> Screen Length From: To: <br /> Driller Onsite: 1(' <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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 /> CHRISMYHolding Temperature: CONFLETION ci;=no_N <br /> Method: G=ndS"rf"' <br /> Screening Method: o�«n <br /> Verified Chain of Custody: ❑ Yes El No <br /> n. <br /> n. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: .toted <br /> aeon F — <br /> Covered: ❑ Yes ❑No x __ t <br /> If yes, material: ` <br /> GROUTING or DESTRUCTION Total Depth: �� <br /> Depth to Water: n- n' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Well 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 ❑Over Drill Filter Pack Type/Size: <br /> T*ravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas eallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest 'q Bags Bentanite/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 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4jc� <br /> 1 25 5 25 so 5 <br /> 2.5 <br /> 15 30 6 30 60 6 l V�Glop 0 f �', "' t 1 <br /> 17.5 35 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 />