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U1" J0A0UIN•SANS, Environmental Health Department <br /> '<•:�'•I=.: —COUNTY— <br /> ` :N4 Y <br /> Greatness grows here. <br /> Monitonr Well/Soil Boring Inspection Report <br /> Date:e* k_ pector: CONSTRUCTION <br /> Facility Address: S L_- C S k1v.t q—tom <br /> Well Address:' Total Depth: <br /> WP# \SucCkI©At1 Well#: Air �N *OS A Drilling Rig Type: <br /> Soil Boring#; \"s is ` <br /> Drilling Company;— ) 4 ��1D Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Driller onsite: I gr" �Wtx, Screen Length From: To: <br /> Consultant: (,&-AN Filter Pack From: To: <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 []No <br /> casing <br /> If yes,location and distance: � height <br /> SAMPLING Aeove-6RouNo ct1�t>m x <br /> Holding Temperature: cowPLErioN o jON <br /> Method: Groundsuta4r�-- --^- <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes []No i . ft. <br /> ft. <br /> SPOILS <br /> o <br /> Contamination Noted: ❑Yes []No " <br /> If yes,spoils storage Location: sbttnd lit= , <br /> Covered: ❑Yes []Nos-cden <br /> S <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: %r ILt 1 w <br /> Depth to Water: �� ^ ` tt. <br /> Grout Material: <br /> Gallons of Grout Used: '�\ MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation &II Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <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 /> ❑ Gravity �1Tremle ❑Other: 0 Sr, Ype ofyMethod- <br /> Water Cement471b Water Cement 541b <br /> Ilons Bags aslions BaRs <br /> Thickest Thinnest #Bags Thickest I Thinnest #Bags Bentonite/Cement Mix 3%Mix 5% Mix_ <br /> 2.5 5 1 5 10 1 1 Bentonite per 471h I IlAll 2.47 <br /> 5 10 2 to 20 2 Bentonite per 94 Ib 1 2.821 4.7 <br /> 7.5 15 3 15 3o 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 20 6 30 60 6 <br /> 17.5 5 85 70 7 <br /> 20 4 B 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95206 1 T 209 468-3420 1 F 209 464-0138 1 Www.sicehd.com <br />