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SAN 10AQUIN <br /> Environmental Health Department <br /> �L"' —C OU N Y— <br /> `�.�' Geotness �rorvs her.' <br /> Monitoring Well/Soil Boring Inspection Report <br /> ,��Date: �� / Inspector: � L CONSTRUCTION <br /> Facility Address: ?� <br /> Well Address: Total Depth: <br /> WP# CGS 5��7 L_�} Well#: Drilling Rig Typed <br /> Soil Boring#: — I <br /> Drilling Company: Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: n ct 61L Screen Length From: To: <br /> Consultant: -L - Filter Pack From: To <br /> g <br /> Geolo lst: ri�* 1 - Bentonite From: To. <br /> r�: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No <br /> casing <br /> If yes, location and distance: height <br /> j�fl 9 <br /> SAMPLING ABOVE-GROUND _ <br /> Holding Temperature: CONPLETION COMPLETION <br /> Method: G=nd Scrtx. <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �N- <br /> t:. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: .bttae <br /> s*cdon — B <br /> Covered: ❑ Yes El No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ZU . <br /> Depth to Water: �,� ft. ' _ tt. <br /> Grout Material: Ce <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: _ <br /> ❑Boring Installation ring 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 ❑Tremie ❑Other: _ Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest 9Bags 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 3 15 30 3 <br /> 10 0 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.slcehd.coni <br />