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COUNTY— Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address:/L. AOO <br /> Well Address: Total Depth: <br /> WP# 'L Well#: Drilling Rig Type: <br /> Soil oring#: �J 'Pc <br /> Drilling Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Company:p y:������ Screen Length From: To: <br /> Driller Onsite:_ .����_�J -,cam <br /> Consultant: �.��7 4�'�N'& 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 /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMfPLEMN coMp�=ct,4 <br /> Method: Ground Surface <br /> Screening Method: pout <br /> Verified Chain of Custody: ❑ Yes El No 1 ft• <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: .tottQd <br /> : — <br /> sat9on :.:F <br /> Covered: ❑ Yes ❑No s��+pacsc <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: -LC) <br /> Depth to Water: Z S ft• " — ft. <br /> Grout Material: <br /> Gallons of Grout Used: NA MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation _❑(Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation EJBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> L27Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bags Rallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 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 <br /> 12.5 25 5 25 50 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 /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sLehd.com <br />