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<JQUINW <br /> EnvironmeF* Health e a en <br /> —COUNTY- <br /> - <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: , ® Inspector: e` CONSTRUCTION <br /> Facility Address: 17 <br /> Well Address: `? Aw<lt Total Depth: <br /> WP# ell#: Drilling Rig Type: <br /> Soil Boring#: �ix-` �5 ►ctl,SwC 1$ <br /> Drilling Company:�w ® ` ®Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: ®1 .` 1 p r Screen Length From: To: <br /> Consultant: W_ ` 7✓ <br /> filter Pack From: To: <br /> Geologist: 1`i <br /> ® entonite From: To: <br /> / ® Grout From: To: <br /> Public Water System Onsite: ❑ es El No MPLETI ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No ca.9ing <br /> If yes, location and distance: height <br /> :Y <br /> SAMPLING <br /> v>=-GnrxnvD tssrY-sox ° <br /> Holding Temperature: COMPLETION comPLErioH <br /> Method: Grodnd$Urf=* <br /> Screening Method: procrt <br /> Verified Chain of Custody: ❑ Yes ❑No • <br /> tt. <br /> ft. <br /> SPOILS <br /> a <br /> — a <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: ' <br /> stonad <br /> Covered: ElYes ❑No acn ' — <br /> a+roi pads <br /> If yes, material: ft <br /> = <br /> GROUTING or DESTRUCTION Total Depth: IS <br /> Depth to Water: - -"' �• <br /> Grout Material: Z.2 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 110 1®®� Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity Premie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> alions Bas eallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest #Bags 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 Ib 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 a <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />