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SQNJOQQU IN Environmental Health Department <br />"i —COUNTY <br />Greatness grows here. <br />�y <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2-12-1612-0101 Inspector: <br />Facility Address: ��1D �lSCL C -110.k*\ &V -Ll <br />Well Address: <br />WP# 003Ct 36L1 Well#: <br />Soil Boring#: <br />Drilling Company: �'lcY�qigas <br />Driller Onsite: Y\,�� <br />Consultant: <br />Geologist: <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />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 AWVE-GROUND <br />Holding Temperature: COMPLETION COMPLETION <br />Method: Ground Surface <br />Screening Method: grout <br />Verified Chain of Custody: ❑ Yes El No �ft. <br />ft. <br />ft. <br />SPOILS y;. _ •: <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: slatted <br />sacdon <br />Covered: ❑ Yes ❑ No g-vw t <br />If yes, material:' <br />GROUTING or DESTRUCTION Total Depth:I so ;: <br />Depth to Water: c) ft n• n' <br />Grout Material: w,,ltk ( roromt � <br />Gallons of Grout Used: 2.4 M't * Z'4 Q&((Ons WMe'r MATERIALS/DEVELOPMENT <br />� Casing Type: <br />❑Well Installation MWell Destruction eO� Blank Feet Screen Feet <br />Slot Size: <br />❑Boring Installation El Boring Destruction Bags of Cement: <br />METHOD USED Bags Sand/Gravel: <br />l913ressure Grout ❑Over Drill Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />❑ Gravity )�Tremie ❑Other: Type of Method: <br />Water <br />Rall s <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />9Bags <br />Thickest Thinnest <br />4Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />Bentonitei ement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />JH b s hentahi CQ�Ii CjfDUf <br />Zq 9x110% C4 tv . <br />/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />