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SANJAQUIN Environmental Health Department <br /> COUNTY--- <br /> ` � Greatness grows here <br /> Srr��ar.. <br /> Monitoring Well/Soil Boring Inspection Report <br /> 1 6►� I <br /> Date: � lig Inspector: V V CONSTRUCTION <br /> Facility Address: L-Os O 1 <br /> Well Address: Total Depth: � � <br /> WP# Well#: Drilling Rig Type: !I �„ <br /> Soil Boring#: <br /> El Min 2"Annular EHD Seal Verified: Yes No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 4 �-r d111 Filter Pack From: To: <br /> Geologist: �-� V k S 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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING A80VE-GROUND _ <br /> Holding Temperature: COWPLErION CC#APLEncN <br /> Method: G=nd Surface <br /> Screening Method: a�«n <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑NoZe <br /> =" _ <br /> If yes, spoils storage Location: sfottaa <br /> Bacton <br /> Covered: ❑ Yes []No <br /> 9-01 Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: t ki <br /> Depth to Water: r&inG6�-t% tL n' <br /> Grout Material: <br /> ti MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation []Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation>�s[Boring Destruction Slot Size: <br /> �� �� 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 Ixremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 94 lb <br /> allons Bas Vallons Bags <br /> Thickest Thinnest aBags Thickest Thinnest tlBags Bentonite/Cement Mix 3% Mix 3% 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 20 4 20 40 4 <br /> 12.5 25 5 25 so 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 3It 0 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.secehd.com <br />