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15 <br />SAN . � OAQ � � N <br />' Environmental Health Department <br />7 <br />r��5�1"' "—COUNTY— <br />�tic� P' Greotness groves here. <br />j Q <br />Monitoring Well/Soil Boring Inspection Report <br />Lb <br />Date: 3 D Inspector: v " CONSTRUCTION l <br />Facility Address: 1 7 <br />Well Address: Total Depth: 5 bl i <br />WP# v Well#: Drilling Rig Type: ` <br />Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No n� <br />Drilling Company: \j VVI <br />Driller Onsite: Screen Length From: To: <br />Consultant: q Filter Pack From: To: Z <br />Bentonite From: To: <br />Geologist: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes El No casing <br />If yes, location and distance: im height <br />SAMPLING AWVE-GROUND <br />Holding Temperature: COWLETION CCa�t�iEnoo-BoN <br />Method: GcoundSutacs <br />Screening Method: grout <br />Verified Chain of Custody: ❑ Yes ❑No �ft. <br />fi. <br />ft. <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: slonoe <br />sataon <br />Covered: 11 Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: I V <br />Depth to Water: <br />Grout Material: L. <br />Gallons of Grout Used: <br />[]Well Installation []Well Destruction <br />❑Boring Installation*oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />)'-J�ravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ltBags <br />Thickest Thinnest <br />sBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 1 <br />80 <br />8 <br />tt. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <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.s4cehd.com <br />