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SANAOA UIN <br /> Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 1 Inspec on S CONSTRUCTION <br /> FacllityAddress: q0 r <br /> Well Address: Total Depth: <br /> WP# OD45150 Well#: Drilling Rig Type: <br /> Sail Boring411Mn Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling y: <br /> Driller Onsite: Screen Length From: To: <br /> nsite: <br /> Consultant: CD tw Filter Pack From: To: <br /> Geologist: 1_VN� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION C]Stove Pipe E lChristie Box <br /> Domestic Well onsite: ❑Yes ❑No ((^^ uas�ng <br /> If yes,location and distance: !' hai-ght <br /> SAMPLING Asovaouep ctuilsrxeox <br /> Holding Temperature: °Oi1ON aoMP1 TIOA <br /> Method: Gryina$u r x.'t ""'--' <br /> Screening Method: eta <br /> Verified Chain of Custody: ❑Yes ❑Noft• <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: <br /> Covered: ❑Yes ❑No stsdon <br /> wsimPack <br /> If yes,material: <br /> GROUTING-or-DESTRUCTION-Total Depth:- r Z01 <br /> Depthto Water: ✓ t ft ft• <br /> Grout Material: MATERIALVDEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation OWell Destruction Blank Feet Screen Feet <br /> ❑Baring Installation ❑ Slot Size: <br /> Boring Destruction Bags of Cement: <br /> METHOD USED Bagssand/Gravel: <br /> ❑Pressure Grout Clover Drill Type/Brand of Bentonite: <br /> Flltei•Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Ce ent 4716 Water Cement%lb <br /> Ions allons Ba s <br /> Thickest Thinnest UBags Thickest Thinnest N lags BentonitelComentMix 3%Pt+llx 5%Mix <br /> as 5 1 5 10 1 Bentonite per471b 1.41 2.47 <br /> s 10 2 v 10 20 z Bentonite per 94 lb 2.82 4.7 <br /> 715 15 8 15 a0 8 <br /> 10 20 4 20 40 4 <br /> 1215 25 5 25 50 5 <br /> is 80 6 30 60 6 <br /> 17.5 85 7 as 70 7 <br /> 20 40 8 40 80 e <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 96206 1 T 209 468-34201 F 209 46"138.1 www.slcehd.com <br />