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f <br /> SANAOA UIN <br /> couNrv— Environmental Health Department <br /> s X <br /> -•s'`.+yynNi°'' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ��- 11, ?, inspector: ^ V%CGS_ CONSTRUCTION <br /> Facility Address; MOSS(�(L�P Vi�1 � <br /> Well Address: Total Depth: <br /> WP# M14_ - Well#: Drilling Rig Type: <br /> Soil Boring#: KW R-lr Min 2"Annular EHD Seal Verified: ❑yes ❑No <br /> Drilling Company:rOO K Driller Onslte: ftm K Screen Length From: To: <br /> Consultant: P_K_T_ Filter Pack From: To: <br /> Geologist; 5drn Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes,location and distance: _�height <br /> SAMPLING �1soy:�Aourlla <br /> Holding Temperature: ccaft�ox <br /> Method: cio nasx(acro f .. —' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑Noft. <br /> SPOILS <br /> Contamination Noted: ❑Yes El No ` r <br /> If yes,spoils storage Location: c 9 <br /> abnad <br /> Covered: ❑Yes ❑Nogravel Pack <br /> �aeaen <br /> If yes,material: <br /> GROUTING-or-DESTRUCTION Total Depl.•...• <br /> Depth to Water: tt <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used e ol 3S <br /> Casing Type: <br /> ❑Well installation ) 1Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> tt��rr��ressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> "'� rtt Filter Pack Type/Size: <br /> El Gravity XTremie ❑Other: Type of Method: <br /> water Cement471b water Cement941b <br /> Ions Ba s gollots Ba <br /> Thickest Thinnest ABags Thickest Thinnest 8Bags 113antonitelCement Mix 3%Mix 5%MIX <br /> 2.5 5 1 5 10 1 Bentonite er47lb 1A1 2.47 <br /> 5 20 2 10 20 z Bentanite per 941b 2.82 4.7 <br /> 7.5 15 3 15 80 3 , <br /> 10 20 4 20 40 4 <br /> 185 25 5 25 50 5 <br /> 35 30 6 30 60 6 <br /> 17.5 <br /> 2 35 H7 35 70 7 <br /> 40 0 40 80 0 ' <br /> 10/16/2017 <br /> 1868 E.Hazelton Avenue I Stockton, California 952061 T 209 468-3420 1 F 209 464-0138.1 www.sicehd.com <br />