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o� <br /> I" �—•!�'__ � —COUNTY— <br /> Environmental Health Department <br /> r r <br /> Greatness grans here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: f/ " '23 Inspector: CONSTRUCTION <br /> Facility Address: ff-4y Q'e•r) ( ief21 S <br /> Well Address: Total Depth: <br /> WP7t yt/elq WeII#) MW A 3e Drilling Rig Type: <br /> Soil Boring#: 6J,x <br /> Drilling Company: G�Y6.7 vr Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: Kkl Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: eY 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 —s casing <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-GflCUND <br /> COI.IPLETION COMPLETION <br /> Holding Temperature: coh4alErioN <br /> Method: Ground xv <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes ❑No n. <br /> _n. <br /> n. <br /> SPOILS c <br /> Contamination Noted: ❑ Yes ❑No 7r <br /> If yes,spoils storage Location: <br /> awned c S <br /> section <br /> Covered: ❑ Yes ❑No — tmvWtack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:t/Sl�j�r(��i5'f = .. <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Z�/cs c K2 �rY <br /> �7 Casing Type: <br /> ❑Well Installation ell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> ,�. Filter Pack Type/Size: <br /> El Gravity AlTremie ❑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 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 is 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 /> 10 40 8 40 80 6 <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 />