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SAN,IOAQUIN <br /> Environmental Health Department r/ <br /> COUNTY— � �Oi { U.�j l/X, ca)Greatness grows <br /> here. II' <br /> Monitoring Well/Soil Boring Inspection Report 1`1-� i <br /> � � I�� <br /> Date: Inspector: :�� CONSTRUCTION � <br /> Facility Address: ( 1 <br /> Well Address: 101W_ F ML6N&otal Depth: -17 <br /> WP# (D 01 Well#: Drilling Rig Type: �� 1)r � 1�� <br /> SDIY I IV e, <br /> Soil Boring#: �? <br /> 11Drilling Company a Min 2"Annular EHD Seal Verified: Yes ❑No <br /> Driller Onsite: / Screen Length From: To: — - <br /> Consultant: <br /> Filter Pack From: To: C. <br /> �- I ✓ <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes QNo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes BNo casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Tempera re: COWLET;ON COWLEnoN <br /> Method: G=nd surtac. <br /> Screening ethod: grout <br /> Verif' Chain of Custody: ❑ Yes ❑No �tt. <br /> fi. <br /> it. <br /> SPOILS <br /> Contamination oted: ❑ Yes ❑No = <br /> If yes, sp s storage Location: sbzt2d _ - <br /> sac9on <br /> Covere ❑ Yes ❑No _ ��Pack <br /> If es, material: _= <br /> ROUTI or DESTRUCTION Total Depth: <br /> Depth to Water: _ ' C - 1 I,ft. = -ft. <br /> Grout Material: ' . / ' �� �/(� `_ L <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction 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 kfremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> gallons Bas wallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest Bags 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 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 1 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 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 />