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SANb10AQUIN <br />'= �' Environmental Health Department <br />—COUNT Y— <br />c5r.ron "'' G-ectriess grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />/Sj Z 3 U <br />1���c'i <br />Date: Z Inspector: CONSTRUCTION <br />Facility Address: &31e'O IA <br />Well Address. Total Depth: <br />WP# 00 ) Well#: '9 Drilling Rig Type: <br />Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Drilling Company: je <br />Driller Onsite: �— <br />Screen Length <br />From: <br />To: <br />Consultant: 1 a✓'hI Ck ey <br />Filter Pack <br />From: <br />To: <br />Geologist: 1 C Y `C- <br />Bentonite <br />From: <br />To: <br />7.5 15 <br />Grout <br />From: <br />To: <br />Public Water System Onsite: ❑ Yes ❑No <br />COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: I JCi <br />Depth to Water: Z.S" <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installationoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity Tremie ❑Other: <br />Water <br />aligns <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />2.5 5 <br />» Bags <br />1 <br />Thickest Thinnest <br />5 10 <br />4 Bags <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Screen Feet <br />Bentonite_ /Cement Mix 3% Mix 5%, Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <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 />