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ppVlly <br /> SANSJ0A0UIR Environmein.dl Health Department <br /> —COUNTY— <br /> T <br /> Greatness grows here. �. <br /> Monito-ing Well/Soil Boring Inspection Report <br /> Date: Inspector: A ee--- CONSTRUCTION <br /> Facility Address: 230 <br /> Well Address: Total Depth: <br /> WP# ML394VA-6631$4 Well#s13,3 Drilling Rig Type: <br /> Soil Boring# - Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: COa <br /> D � 'e v Screen Length from: To: <br /> Driller Onsite: <br /> : Y�—✓�� �� Filter Pack From: To: <br /> Consultant Bentonite From: To: <br /> Geologist: : <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 Aeo`E-GaaUNo crsilstYsox <br /> Holding Temperature: 00WLEnON CottPlEnw <br /> Method: Ground— s� <br /> Screening Method: Qf0w <br /> Verified Chain of Custody: ❑ Yes ❑Nott. <br /> Y <br /> SPOILS <br /> _ e <br /> Contamination Noted: ❑ Yes ❑No <br /> o <br /> If yes,spoils storage Location: .toned Si = B <br /> sar.'on <br /> Covered: ❑ Yes ❑Nc = yra,rel Peck <br /> If yes, material: 6-1- <br /> GROUTING or DESTRUCTION Total Depth: /7 <br /> Depth to Water: *V <br /> Grout Material: eaeti t" MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 9'x—,9k Casing Type: <br /> lWell 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 /> ❑ Gravity ❑Tremie [KOther: f"e 4ty Type of Method: <br /> Water Cement 471b Water Cement 9416 <br /> allons Bags altons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 5%Mix_ <br /> 255 s 1 5 10 1 Bentonite er47lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.62 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 11.5 25 5 25 so 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 1 <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 />