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i <br /> SAK JOA UIN Q Environmental Health Department <br /> EBSr'�r",s;'1 COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: l0 1 "2;0* inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: ew29 ,,e er$ Total Depth: <br /> WP#ey L1074fo Well#: Alllvr^7 Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: £S/a5a/e a t.. Screen Length From: To: <br /> Driller Onsite: 4R6 Jt <br /> Filter Pack From: To: <br /> Consultant: <br /> Bentonite From: To: <br /> A_n-O, Tw Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes ENO � casing <br /> If yes,location and distance: � height <br /> SAMPLING ABOVE-GROUND CHAtM43OX <br /> Holding Temperature: 0Ot"FLETpN COMPLEnoN <br /> Method: around surlacv <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes PRo n' <br /> n. <br /> _n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes &3 o <br /> If yes,spoils storage Location: �wttad — 8 <br /> a*ctlon _ <br /> Covered: ❑ Yes ❑No = gra w Pack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 54� r �'r /4,?r / n' — n' <br /> Grout Material: Pot>F ten%^,& sS��AFtifw 4 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> []Well Installation IlTrMell Destruction r` M2 Qlank Feet Screen Feet <br /> Q'0 b/^�zCe.�lotSize: <br /> ❑Boring Installation El Boring Destruction �e �S 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 R remie ❑Other: Type of Method: <br /> Water cement 471b r ent 41b <br /> allons Bags gallons 8 s _ <br /> Thld est Thinnest Mits Th Thinnest pB89s _ Bentonite/Cement Mix 3% MIX 5% Mix <br /> 2.s s 1 s l0 1 Bentonite per 47 lb 1.41 2.47 <br /> s to z 10 20 2 Bentonite per 94 lb 2.82 <br /> Is 15 3 15 30 3i- <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 •''�"^`�`�`Q � '�• �`+'�-�/' -4� <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 <br /> 20 40 B 40 30 0 Lr+L Y<Y <br /> 70^/lOo 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 />