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SAW]OAQUIN Environmental Health Department <br /> —COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:14 D Z4(q Inspector: SCl CONSTRUCTION <br /> Facility ddr ss: 2q°12LA C t '2 0 �PSCak,T_'_ <br /> Well Address: Total Depth: <br /> WP# CZ 's Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> �np Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: (u1 U S(�,�,TE <br /> Driller Onsite: J 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 ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVEGROUND <br /> Holding Temperature: COWLET ON CCOOWLETICN <br /> Method: G3rnund Surface <br /> Screening Method: gro«e <br /> Verified Chain of Custody: ❑ Yes El No .L�tt- <br /> tt. <br /> Jt. <br /> SPOILS = <br /> — - e <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes, spoils storage Location: <br /> .bttsd _ � <br /> a�cdon _ $ <br /> Covered: ❑ Yes El No _ vw <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: h <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> E]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 kTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas lZallons Bags <br /> Thickest Thinnest IBags Thickest Thinnest frBags Bentoni Cement 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 /> 1 25 25 50 5 <br /> 155 30 6 30 60 6 1 `tea J w ! 12 jalU rW tv� �1-Cr <br /> 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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />