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SANJOA UIN <br /> Q Environmencai Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date-4 Inspector: CONSTRUCTION <br /> Facility Address: 3 S/ /f <br /> Well Address: YJ Total Depth: (� � <br /> WP# b Well#: A � i� Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: ✓ <br /> Driller Onsite: W r V Screen Length From:: To: Z/15 <br /> Consultant: { t 3 Filter Pack From: To: <br /> Geologist: C r Bentonite From: 1� To: � <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No cas ng <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> COMPLETION GHR151Y-BOX <br /> Holding Temperature: compuE ioN <br /> Method: Ground sut:. <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ONO e. <br /> H. <br /> SPOILS <br /> Contamination Noted: ❑Yes ONO == <br /> If yes,spoils storage Location: sla 3 <br /> tted <br /> wecdon _, 3 <br /> Covered: ❑ Yes El No gr+W lack <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION,Total Depth: <br /> Depth to Water: N <br /> Grout Material: n L MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: �i <br /> Casing Type: .P\ <br /> Well Installation ❑Well Destruction Blank L_"i- Feet Screen_? ) Feet <br /> Slot Size: t1j rl(l <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: r �. <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 9411) <br /> allons Bags eallons Ba s _ <br /> t7.515 <br /> %Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX rJ%MIX 1 5 10 1 Bentaniieper47lb 1.41 2.47 2 10 202 Bentonite per 941b2.82 4.7 3 15 30 3 , <br /> 4 20 40 4 25 50 5alsi�30 60 6 'rA,(G � t ys T`b1`35 70 7 � .yam rn 8 40 80 \" <br /> r�ti .li}e� 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sicehd.com <br />