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SAN�:10A UIN <br /> Q Environmental Health Department <br /> lK ! y <br /> —COUNTY— <br /> f,; Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:A ) Inspector: CONSTRUCTION <br /> Facility Address: �O`?'k- 't�C-4�_ <br /> Well Address: Total Depth: <br /> WP# `" Q Well#: N 11>\ Drilling Rig Type: <br /> Soil Boring#: c')-1,C) \� "J 'J Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: <br /> Consultant:' Filter Pack From: To: <br /> \ \�� ' -�1 �_ <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 PNo casing <br /> If yes, location and distance: height <br /> SAMPLING AMVE-GROUND <br /> Holding Temperature: CO&FLEC)oN CCUPLErTON <br /> Method: G=rjd SWacs <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> 72 <br /> If yes, spoils storage Location: stoned <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTIO Total Depth:\:'Zl <br /> Depth to Water: <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 /> El Boring Installation/Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> l Filter Pack Type/Size: <br /> VJ Gravity ❑Tremie ❑Other: Type of Method: <br /> (( Water Cement 471b Water Cement 941b <br /> gallons Bas gaill ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags BentoniteXement 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 1 25 1 5 25 50 5 <br /> 15 1 30 1 6 30 60 6 <br /> 17.5 7 35 70 7 <br /> 20 40 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />