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Op a o\ <br /> /_'. �,�l S A Nsd 0AQ U IN Environmental Health Department <br /> 4" L�!1 —COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: k�WL-3>spector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: NS ¢io%jQm_ Total Depth: �� \ <br /> WP#_ 1� CA % (o Well#: Drilling Rig Type: _ I11�(st p� L I✓(0(�I�6� 5��c� ) <br /> Soil Boring#: ?� 'Jo�� Q�,'p��`,�,� S�`� <br /> Drilling Company: �An/�M�4��r��P•� c, Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: �� Q.� ���Screen Length From: S k To: -7 °j <br /> Consultant: P 5 )'SFilter Pack From:_ To: SS <br /> Geologist: E-l/ S Bentonite From: S S To: 5 <br /> Grout From: 5 S To: <br /> Public Water System Onsite: ❑Yes �No COMPLETION ❑ Stove Pipe I Christie Box <br /> Domestic Well Onsite: 5?l Yes ❑No casing / <br /> If yes, location and distance: �A 5 height <br /> SAMPLING <br /> AWVS-dROUND CHRl3 MBOX <br /> Holding Temperature: COMpLEa•jDN <br /> Method: Grodnd 5�tac+ <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes VNo <br /> S it. <br /> SPOILS - — <br /> Contamination Noted: 1­71Yes "" ❑No = n <br /> If yes,spoils storage Location: <br /> .a <br /> slo loud <br /> s+o;on <br /> Covered: Yes ❑No <br /> If yes, material: M'yy�s•- <br /> GRO G r DESTRUCTION Total Depth:_ 5 <br /> Depth to Water: S� \n- tt. <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> //Well Installation ❑Well Destruction Blank �QP _Feet Screen '2JD Feet <br /> Slot Size: - O'L._� <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: 'ZZI \Z— <br /> ❑Pressure Grout 1710ver Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity iremle []Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bags Raillons Bags <br /> Thickest Thinnest Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 5% MI<X <br /> 2.5 5 1 5 10 1 _Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonife per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 i <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 4 @ 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 IF 209 464-0138 1 www.sicehd.com <br />