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=oPcuiN�z\ SAN,00ANIN <br /> Environmental Health Department <br /> —COUNTY— <br /> Greatness <br /> COUNTY— <br /> S4, P' Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: M/r�l�Y Inspector:A/z[e4"•— CONSTRUCTION <br /> Facility Address: /z-,50 <br /> Well Address: Total Depth: <br /> WP# Osn341- Well#: Drilling Rig Type: c�S <br /> Soil Boring#: Al$y Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 1-,4 64/ <br /> Driller Onsite: �/�&4k- Screen Length From: To: <br /> Consultant: n ` Filter Pack From: To: <br /> Geologist: Aa d Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION CCMPLEnCN <br /> Method: Grvurd Sudacs <br /> Screening Method: Pt grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> n. <br /> n. <br /> SPOILS = <br /> e <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: atonaa <br /> aac'on <br /> Covered: ❑ Yes ❑No <br /> Q-vw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: uEi <br /> Depth to Water: n tt. <br /> Grout Material:-*0-01fcess <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> ❑Boring InstallationABoring Destruction gags Slot Siziz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> APressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ITremie ❑Other: Type of Method: <br /> at ent 471 Water Cement 941b <br /> all Ba allons Bags <br /> Thickest Thinnest uBags Thickest Thinnest »Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 16 1 Bentonite per 47 Ib 1.41 2.47 <br /> . 15 2 15 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 1 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 /> l't 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />