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AN J U A V U I N Environmental Health Department <br /> COUNTY— <br /> _ Greotness Grens i,ere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: tV ?r-1 Inspector: Lw CONSTRUCTION <br /> Facility Address: 17Z71 tyct (n%,4 L�. <br /> Well Address: Total Depth: <br /> WP# 00599 13 Well#: Drilling Rig Type: <br /> Soil Boring#: CPT i S CYT tLaeltb <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company:_C.�ff , Screen Length From: To: <br /> Driller Onsite: t IcQ <br /> Consultant: 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 ca-Ing <br /> If yes, location and distance: night <br /> SAMPLING AWVc-GFICUND <br /> Holding Temperature: cc.&L_EnON ���r�t <br /> Method: <br /> Screening Method: grout <br /> Verified Chain o CCustody: ❑ Yes ❑No k__ __ - <br /> i#_ <br /> ft- <br /> SPOILS <br /> ••^AF <br /> Contamination Noted: ❑ Yes ❑No = a <br /> If yes, spoils storage Location: <br /> 2Of _ <br /> Covered: ❑Yes ❑No <br /> I;G j , <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:SUA <br /> Depth to Water: tt N LF <br /> Grout Material: rv<AA- <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: LOG . Casing Type: <br /> [--]Well Installation ❑]�Well Destruction Blank Feet Screen Feet <br /> [ Boring Installation E oring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> �� Filter Pack Type/Size: <br /> El Gravity [P remie ❑Other: Type of Method: <br /> Water cement 471b Water cement 941b <br /> gallons Bas galill ons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest #Bags BentonitelOement 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 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 7209 468-34201 F 209 464-0138 1 www.slcehd.com <br />