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3 A N ,JUAQUIN <br /> Environmental Health Department <br /> I ' i —COUNTY— <br /> =a: - <br /> Greatness Gres ,fere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: LJ Inspector: CONSTRUCTION <br /> Facility Address: l'3M 97s6,1 L d-_iRe.Gto <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: k,- Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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 /> V —w <br /> SAMPLINGovc��ouNo w' FON CHRIS"FY-BOX <br /> Holding Temperature: CCW ET!.ON <br /> Method: <br /> Screening Method: QfO <br /> Verified Chain of Custody: ❑ Yes ❑No —f" <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No == <br /> If yes,spoils storage Location: - <br /> "---Jan <br /> Covered: ❑ Yes ❑No _ <br /> Ifyes, material: <br /> GROUTING or DESTRUCTION Total Depth:It _ <br /> Depth to Water: Ta s..,44,• <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOP IM ENT <br /> Casing Type: <br /> Dell Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation El 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 Neremie ❑Other: Type of Method: <br /> Water Cement 471b Water cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 4Bag5 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 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 Z �L r / rji/ <br /> 12.5 25 5 25 50 5 C '7C- <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 1 70 7 / <br /> 20 40 B 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.slcehd.com <br />