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SAN 10A0UIN <br /> Environmental Health Department <br /> COUNTY - <br /> i <br /> °giFoa?`P Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Zci.7-�nspector: �i t�- A ' CONSTRUCTION <br /> Facility Aclress: -S m lZ� <br /> Well Address: Total Depth: <br /> WP#f00q'0 1 Well#: Drilling Rig Type: S P <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: r <br /> Driller Onsite: � Screen Length From: To: <br /> Consultant:/�� y��pa–�'�/ Filter Pack From: To: <br /> Geologist: t-G p� J 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: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: cou,FLETION CIOMPLEnON <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes 11 No <br /> ft. <br /> ft. <br /> SPOILS K =_ <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted <br /> s�cJon _ <br /> Covered: ❑ Yes ❑No __ graw+tack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: VZO k1Z <br /> Grout Material: <br /> Gallons of Grout Used: ,— p. <br /> U , MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation 1Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity �Tremie ❑Other: Type of Method: <br /> Water Cement 71b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest rrBags Thickest Thinnest aBags 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 /> /'Q �A � b�►ry� 10/16/2017 <br /> 11868 , Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />