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SAN MAUI,, Environmental Health Department <br /> - COUNTY— <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: _ Total Depth: y� <br /> iAl <br /> WR# © l� `� Well#: Drilling Rig Type: (7-'7 <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified, ❑ Y- <br /> Drilling Company: Screen Length From: USI o: -� <br /> Driller Onsite: <br /> Consultant: Gc yGIR- PQ r Filter Pack From: �! �BT3,5 <br /> 0. <br /> Geologist: M i V 1 CL VN Bentonite From: To: _ IS <br /> Grout From:s , —To:___ _ <br /> Public Water System Onsite: ❑ Yes ` Vo COMPLETION ❑ Stove Pipe ;khristie Box <br /> Domestic Well Onsite: ❑ Yes VINo casing <br /> If yes, location and distance: height <br /> iii <br /> SAMPLING AZOVE-GROUND <br /> Holding Temperature: COWLET;ON CDMP=CN <br /> Method: Ground Swlacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> ft. <br /> ft. <br /> SPOILS _ <br /> = m <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> slotted <br /> Covered: El Yes ❑No �p _ Iii Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 3 <br /> Depth to Water: <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: S (�T <br /> Casing Type: 1 V <br /> U'Well Installation ❑Well Destruction Blank ZO Feet Screen 15 Feet <br /> Slot Size: D <br /> 11'❑\Boring Installation ❑Boring Destruction � <br /> Bags of Cement: Y <br /> METHOD USED Bags Sand/Gravel: % , Z <br /> Type/Brand of Bentonite: A 2 <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: 2-(7 <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest )t Bags Thickest Thinnest .Bags 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 /> 12.55 25 50 5 <br /> 15 0 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 a0 s 40 e0 s <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 />