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Y SAN 10AQUIN <br />--COUNTY <br />Gieutness grows hers. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />11,-- <br />Date: -1 /ZqInspector: CONSTRUCTION <br />Facility Address: <br />Well Address: Total Depth: <br />WP# Well#: Drilling Rig Type: �'� Iva <br />Soil Boring#: <br />Min 2" Annular EHD Seal Verified: El Yes 1:1 No <br />Drilling Company: <br />Driller Onsite: 0 <br />Screen Length <br />From: <br />To: <br />Consultant: =Cme 1 S410Z <br />Filter Pack <br />From: <br />To: <br />Geologist: r, nA <br />Bentonite <br />From: <br />To: <br />10 <br />Grout <br />From: <br />To: <br />Public Water System Onsite: ❑ Yes El No <br />COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: ,5© <br />Depth to Water:cad rs2'1� n <br />Grout Material: C--kAj "�ATERIALS/DEVELOPMENT <br />Gallons of Grout Used: <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />❑Boring Installation'XBoring Destruction Slot Size: <br />Bags of Cement: <br />METHOD USED Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />❑Pressure Grout ❑Over Drill <br />Filter Pack Type/Size: <br />❑ GravityTremie 4Other: Type of Method: <br />��� rL ," n:r.A <br />Water <br />gall] s <br />Cement 471" <br />Bas <br />Wa er <br />sezallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />4Bags <br />Thickest Thinnest <br />"Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />20 <br />30 <br />40 <br />3 <br />4 <br />10 20 4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />EB <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />40 <br />80 <br />8 <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />9entonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />