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1 SANr,J0A0UIN <br /> I - •<i••-T� —COUNTY— Environmental Health Department <br /> , Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: O� �'�j Inspector: CONSTRUCTION <br /> Facility Address: 6110-14\ <br /> Well Address: Total Depth: <br /> WP# ��.O�o _Well#:�vJ- 0 05 Drilling Rig Type: <br /> Soil Boring#: w` l�nvJ-\\dP" <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ❑Yes El No <br /> Driller Onsite: IYC__ Screen Length From: To: <br /> Consultant: 6-(C S9 n'y\�L Filter Pack From: To: <br /> Geologist: ghc.k_ 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 casing <br /> If yes, location and distance: ', height ; <br /> SAMPLINGABOgG�, flo <br /> Holding Temperature: ooMPLETION -Box <br /> COMPLETION <br /> COMPLETION <br /> Method: GmUnd 8u 1a4e T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑Nofl- <br /> _� ft. <br /> SPOILS -- <br /> Contamination Noted: ❑Yes ❑No x~• - Y <br /> G _ <br /> If yes,spoils storage Location: <br /> sacdon — $ <br /> Covered: ❑Yes ❑No <br /> If yes, material: gravapeck <br /> GROUTING or DESTRUCTION Total Depth: 0�1 •5 1 _ <br /> Depth to Water:_ tt m n <br /> Grout Material: !J 1C� <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation RIWell Destruction Blank Feet Screen Feet <br /> ❑boring Installation ❑ Slot Size:Boring Destruction 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 OTremie AOther: ��\TES � Type of Method: <br /> Water Cement 471b ' ��Water Cement 941b it <br /> Ilan Bags gallons se s j <br /> Thickest Thinnest 4sags Thickest Thinnest aeags BentonIWCementMlx 3%Mix 5a/a MIX_ <br /> 2.5 s 1 5 10 1 Bentonite per 47lb 1.41 2.47 <br /> 5 20 2 20 20 2 Bentonite per 941b 2.82 4.7 <br /> 7.5 is 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 11.5 25 5 25 50 5 <br /> 15 30 6 3o 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 NO-7 40 00 0 <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 />