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�Q SA N J 0 A 0 U I N Environmental Health Department <br /> —COU NTY-- <br /> cg4Fow'�PJ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: / u-� �� Inspector: !yj CONSTRUCTION <br /> Facility Address: <br /> Well Address: a!, A4 Total Depth: �S <br /> WP#604 Z 7 7 3 Well#: Drilling Rig Type: <br /> Soil Boring#: "Z <br /> Drilling Company: cf Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> "7'��✓ <br /> Driller Onsite: I�i 1rc'6 .r'�Z'— Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: r� -eta <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: WT <br /> height . <br /> W7:F <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION CCOMPLEnoN <br /> Method: G=nd Surf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> it. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stood = . <br /> scion <br /> Covered: ❑ Yes ❑No g-w+tack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Tol Depth: 5- <br /> Depth to Water: 43157 <br /> n' <br /> Grout Material: dt.4?!&C.,e� 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 Woring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> []Pressure Grout []Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity firemie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />