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amu'" z SANQ <br /> JOAUIN <br /> Environmental Health Department <br /> '•i ` <br /> —COUNTY— <br /> .q <br /> 4. <br /> COUNTYq4. Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: /Zv Inspector: Vf CONSTRUCTION <br /> Facility Address: <br /> Well Address: J Total Depth: ! <br /> 11 � <br /> WP# 6 Well#: Drilling Rig Type: cl C �C '6 <br /> Soil Boring#: <br /> Drilling Company: - ,� ��jp Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite4'lko <br /> Screen Length From: To: <br /> Consultant: <br /> 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: height <br /> SAMPLING ABOVE-GROILIND <br /> Holding Temperature: COWPLETION ccmPLEnoN <br /> Method: Ground Su face <br /> Screening Method: ori <br /> Verified Chain of Custody: ❑ Yes L1 No �R• <br /> tt. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: <br /> s+cdon — 8 <br /> Covered: ❑ Yes ❑No =' <br /> on+W pack <br /> If yes, material: /] <br /> GROUTING or DESTRUCTION Total De the `J C?�0`-1 • =_ <br /> Depth to Water: � — n• <br /> Grout Material: <br /> Gallons of Grout Used: <br /> 6 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring InstallationtAoring Destruction Bags Size: <br /> 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 Ceme b Water Cement 941b n� J <br /> allons Ba 111 s BagsJ <br /> Thickest Thinnest 4Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 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 50 5 <br /> 15 I Im 30 60 6 <br /> 17.5 35 70 7 <br /> 20 8 40 80 8 <br /> C2"X ?p U I 6 Wflj 10/16/2017 <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 />