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SANAOAQUIN Environmental Health Department <br /> COUNTY— p <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:iL -iz i9 Inspector: vo-a CONSTRUCTION <br /> Facility Address: /9/do W• YLLt erA, <br /> Well Address: Total Depth: <br /> WP# u0Y03z-F Well#: Drilling Rig Type: <br /> Soil Boring#: 81 td 8s <br /> Min 2" Annular EHD Seal Verified: E] Yes []No <br /> Drilling Company: <br /> Driller Onsite: r)h'� Screen Length From: To: <br /> Consultant:_ �,�a «- Filter Pack From: To: <br /> Geologist: 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 /> SAMPLING ABOVE-GROUND C4iR_ <br /> Holding Temperature: CONFLETION CotNPLEnoN <br /> Method: G=nd Sudan <br /> Screening Method: er«A <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No s/ f =` _ <br /> If es, spoils storage Location: B3 <br /> Y g sbttad �; — <br /> /�y;,3 y�s�cdan r <br /> Covered: ❑ Yes El No 1g—W Pack <br /> Yfk <br /> If yes, material: << �< <br /> GROUTING or DESTRUCTION Total Depth: S- <br /> Depth to Water:-13' n• tt• <br /> Grout Material: A/uc <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation []Well Destruction g j Mis' Blank Feet Screen Feet <br /> � 7 Slot Size: <br /> ❑Boring Installation RBoring Destruction 8z' i Bags of Cement: <br /> 13J 5' <br /> METHOD USED S Bags Sand/Gravel: <br /> JV Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill &reZ3 Filter Pack Type/Size: <br /> ❑ Gravity RTTremie ❑Other: Type of Method: <br /> a Cemtnt-Mb Water Cement 94 lb <br /> all "s 7-Bags- eallons Bags <br /> Thickest Thinnest ttBags 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 S0 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 3� <br /> IL- 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />