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I <br /> $QN�-)OQQ(JIN � Environmet._al Health Department <br /> —COUNTY— <br /> \ <br /> Greatness grows here. <br /> l� Monitoring Well/Soil Boring Inspection Report <br /> Date: -7,02b Inspector: _ CONSTRUCTION <br /> Facility Address: 't3St10 to � <br /> Well Address: Total Depth: <br /> WP# Sa`k`13 Well#: NN-2-2 Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: Bentonite From: To:- <br /> Geologist: Grout From: To: <br /> Public Water System Onsite: Yes ❑No COMPLETION ElStove Pipe ❑Christie Box <br /> Domestic WellOnsite: IYes ❑No casing <br /> If yes,location and distance: �i70r height <br /> SAMPLING ABOVE-d amo c+wlsTi Box <br /> COMPLETION COMPLETION <br /> Holding Temperature: Graind sung. <br /> Method: grout <br /> Screening Method: <br /> Verified Chain of Custody: ❑ Yes ❑No n. <br /> SPOILS = e <br /> F = A <br /> Contamination Noted: ❑Yes ❑No A, <br /> If yes, spoils storage Location:.aion.d 8 <br /> aActon <br /> Covered: El Yes ❑No _ g.v.t Pacts <br /> If yes,material: " <br /> GROUTING or DESTRU TION Total Depth: n = tt. <br /> Depth to Water: bk) <br /> Grout Material: wtC o< t I��� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 15 eaA Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> Slat 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 ❑Other: <br /> Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> as Ba s allom Ba s <br /> Thickestllon Thinnest4aags Thickest Thinnest ABags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 lBentonite per 94 ID 2.82 4.7 <br /> 7.5 15 3 15 30 3 i <br /> 10 20 4 20 40 4 <br /> 12.5 5 25 50 5 <br /> 15 3 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 1 40 B 40 Bit 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 />