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SAN�IOAQUIN <br /> �O. <br /> Environmental Health Department <br /> —COUNTY— <br /> Greatness Greatness grows here. <br /> Monitoring ,.W{, ell/Soil Boring Inspection Report <br /> Date: � Inspector: S((� y' CONSTRUCTION �� , /� <br /> Facility Address: o G y, 11 Ovil wi- �LllkhatIc wett <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: (M-7W&-1 (brfD in 2" Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: �(l�y V , w (��ai� 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: TffLf height <br /> off— <br /> SAMPLING ABOVE-GROUND _ <br /> Holding Temperature: COWf�IoN OMPLEnON <br /> Method: Gnxind Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �fe' <br /> ft. <br /> tt. <br /> SPOILS . <br /> e <br /> Contamination Noted: ❑ Yes ❑No ° <br /> If yes,spoils storage Location: stoned <br /> soon <br /> Covered: ❑ Yes ❑No = g,,,lw v <br /> If yes, material: <br /> ROUTING DESTRUCTION Total Depth: kff-t .• <br /> Depth to Water: n• n' <br /> Grout Material: (rysQwti <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction 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 ❑Tremie ❑Other: Type of Method: <br /> Water ment 471b Water Cement 941b <br /> allons Bags— <br /> allons Bags <br /> Thickest Thinnest ags Thickest Thinnest ttBags Bentonite/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 /> 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 /> 2690w i �11 kw 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.s'cehd.com <br />