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S Q N J 0 QQ W. Environmei i ial Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I t3 "� Inspector: CONSTRUCTION <br /> Facility Address: 3-7 S kl- fa+.. 04-1- <br /> Well Address: Vw -3 Total Depth: <br /> WP# 00(to&VSS Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company:Ii>Xd It Sle Screen Length From: To: <br /> Driller Onsite: q276 a S<< <br /> Filter Pack From: To: <br /> Consultant: A it /rc.� Ek-�'�+'�� <br /> Bentonite From: To: <br /> Geologist: Ices 1 �1 <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height: <br /> SAMPLING ABOVE-GFICUND CHRI.M43OX <br /> H COMPLETION COMPLETION <br /> Holding Temperature: <br /> C3rcund suriac. <br /> Method: <br /> Screening Method: Afl grout <br /> Verified Chain of Custody: ❑ Yes ❑No n, <br /> ft. _ <br /> SPOILS ¢ _ <br /> Contamination Noted: ❑ Yes El No = ` <br /> If yes, spoils storage Location: atottod <br /> sac'on <br /> Covered: ❑ Yes El No gr„retpxic <br /> If yes, material: Viv-3 Lf► <br /> GROUTING or DESTRUCTION Total Depth: �Ie' •'` <br /> Depth to Water:—10 t <br /> Grout Material: lVi24Fcf-V40C MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation kWell Destruction Blank Feet Screen Feet <br /> Slot 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 /> K Gravity al' remie ❑Other: Type of Method: <br /> V PV 3 A.V-ZL-, -13 <br /> Water Cement 471b water Cement 941b <br /> allons Bags Rallons Bags <br /> Thickest Thinnest kBags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 s 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 75 15 3 15 30 3 <br /> 10 20 4 20 40 4 ',t 4 t 7,5'�p i4j,* 136 4.r.AA 9N 14, &!, C Z. <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 �.`7 Z l S)47,o 4>nHj j LC v 4 K iha VW-3 <br /> 17.5 35 7 35 70 7 �IhS �AN/��3 <br /> 20 40 B 40 80 B j)li X'1,S;4 i` Z gi5rj2G� bass ce.%&% /I <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 />