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SANdOAQUIN Environmental Health Department <br /> / COUNTY <br /> Greatness grows here <br /> ii Monitoring Well/Soil Boring Inspection Report <br /> Date: 1C1�� I i�� Inspector: �hy%k?na 5. CONSTRUCTION <br /> Facility Address:ti(an(;o w scY)ukic <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: e Or <br /> Soil Boring#:A2i X25 3t-T) <br /> Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: 'y 8, W <br /> Driller Onsite: e� Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <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 ABOVE-GROUND <br /> Holding Temperature: 1OIF�toN �iFnoN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �n. <br /> n. <br /> ft. <br /> SPOILS - — <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted <br /> sacdon = B <br /> Covered: ❑ Yes ❑No <br /> gmvlw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: rJ� �� � l 10F}GO <br /> Depth to Water:—t,)c:„P_ <br /> Grout Material: %.j-j)& (leffy-c1t <br /> oi✓ car{1 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: '3 <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> ❑Boring Installation CZIBoring Destruction Bags Slot Siziz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity OTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest aBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3% 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 /> 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 />