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Q ppuiN'�.1� C A N X10 A Q U I N <br /> Environmental Health Department <br /> " <br /> —COUNTY— <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: L�j' CONSTRUCTION <br /> Facility Ad ress: <br /> Well Address: V Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: , 8T is Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company: -- pV-,r0. 6cy1 <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: �1/ Y-�� <br /> Bentonite From: To: <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: height <br /> SAMPLING ABOVE-GROUND <br /> CHRHolding Temperature: COMPLETION compt�_.EnoN <br /> Method: Ground Surface T <br /> Screening Method: I cry <br /> Verified Chain of Custody: El Yes ❑No J n. <br /> ft. <br /> SPOILS 2 3 <br /> e <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: ]p (Ij stoned _ C S <br /> eacson <br /> Covered: ❑ Yes ❑No = g.,w P.* I I <br /> If yes, material: = cuo/ <br /> GROUTING or DESTRUCTION Total Depth:—LQ-d5 <br /> Depth to Water: 6+ ' it. & <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation*oring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 941b <br /> gall s Bas gallons Bags <br /> Thickest Thinnest xBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 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 /> 7.5 15 3 15 30 3 <br /> 10 204 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 35 70 7 <br /> 20 40 8 40 80 8 <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.sacehd.com <br />