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SA NUJ M I N <br /> � — Environmental Health Department <br /> ".i COUNTY— <br /> Greatness grows here. <br /> G Monitoring Well/Soil Boring Inspection Report <br /> Date: ( Inspector: �f CONSTRUCTION <br /> Facility A dress: <br /> Well Address: Total Depth: <br /> WP# f3Q�LA O Z & Well#: Drilling Rig Type: <br /> Soil Boring#: �,2 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: (�)oQ�1' <br /> Driller Onsite: k- Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: vv-- Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> ++ T <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: 00t"��ION c�ompt.EnoN <br /> Method: G=ndSurfa" T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> n. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes []No =` <br /> If yes, spoils storage Location: stoned = . <br /> sat3on r_ — <br /> B <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> 'C <br /> Depth to Water: o Duy\o( � n• — tt' <br /> Grout Material: yVL�_'V 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+ring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity +emie ❑Other: Type of Method: <br /> Water rCer6ent 471b Water Cement 941b <br /> allons Basgallons Bags <br /> Thickest Thinnest 1t Bags Thickest Thinnest bBags 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 www.socehd.com <br />