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SAN 10AQUIN <br /> Environmental Health Department <br /> S 0-i'_._ COUNTY <br /> Greatness grows here <br /> ,�l Monitoring Well/Soil Boring Inspection Report <br /> Date: � 2V("I��}}lnspector:��l �� CONSTRUCTION <br /> Facility Aid res : 2 6t1 )_L1 F ,�fi Es'cstlum <br /> Well Address: Total Depth: <br /> WP# 3 2 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: S n o <br /> Driller Onsite: CoaW Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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: CONFLE ION c�tFncN <br /> Method: C3=no Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> ft. <br /> tt. <br /> ft. <br /> SPOILS <br /> = e <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: slotted <br /> sac�on = S <br /> Covered: ❑ Yes ❑No = �� <br /> If yes, material: x <br /> GROUTING or DESTRUCTION Tota) Depth:�IrOU'rg�(iloo-F t : <br /> Depth to Water: (� 25p n• IFn <br /> Grout Material: gentni'E-Q, MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ,Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring 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 /> ❑ Gravity T,Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bas <br /> Thickest Thinnest 9Bags Thickest Thinnest Jt Bags BentO ICemertt MIX 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> . 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 10 20 4 20 40 4 15 3 15 30 3 TQr �� S > W(� <br /> 12.5 25 5 25 50 5 <br /> baQ <br /> 15 30 6 30 1 60 6 -J <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 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.s4cehd.com <br />