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SQN .JOQQUIN Environmental Health Department <br /> fF" —COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 3 7iv t°/ Inspector: l .-I CONSTRUCTION <br /> Facility Address: t l 1 Comic w <br /> Well Address: Total Depth: <br /> WP# pJ:)ti 3o 3 Well#: Drilling Rig Type: <br /> Soil Boring#: Q N , 137- 1 13 30 1314 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 1 t,►�rw[e h <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: �r+�.C.o Filter Pack From: To: <br /> Geologist: U-v�s <br /> 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 /> iii7 <br /> � <br /> SAMPLING ABOVE-GRCUND <br /> Holding Temperature: COWLETION CCWLEnoN <br /> Method: Ground SLe=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft' <br /> ft. <br /> ft. <br /> SPOILS <br /> _ - o <br /> Contamination Noted: ❑ Yes ❑No -` <br /> If yes, spoils storage Location: <br /> sacdon '– <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ft• ft' <br /> Grout Material: ' MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used" c,"(or7c -crci�4 <br /> _j — Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ormg 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 El Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 1 20 4 20 40 4 <br /> 12..5 25 5 25 50 5 <br /> 1s 30 6 30 60 6 <br /> 35 7 35 70 7 <br /> 2 (1/ � • p� <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.socehd.com <br />