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QPQUIN C <br /> SQN.sJOQQUIN Environmental Health Department <br /> —COUNTY <br /> \�yr Greatness grows here. <br /> ll 77 <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: '7 G �� Inspectors�I ��� rl CONSTRUCTION <br /> Facility Address: Ll A/ <br /> Well Address: Total Depth: <br /> WP# r-") Well#: Drilling Rig Type: . <br /> Soil Boring#: c <br /> Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: <br /> Filter Pack From: To: <br /> Geologist: ��r,�1P� <br /> 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 <br /> Holding Temperature: CO�`F�ION ccoMPLEnoN <br /> Method: G=nd&xfaet <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> h. <br /> ft. <br /> SPOILS k <br /> Contamination Noted: ❑ Yes 11 No a� <br /> M — r <br /> If yes, spoils storage Location: slotted = B <br /> n <br /> soo "7 — <br /> Covered: ❑ Yes ❑No y = g-vW pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: —fL n' <br /> Grout Material: <br /> Gallons of Grout Used: 2 MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation�Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cemen 471b Water Cement 941b <br /> allons Ba allBags <br /> Thickest Thinnest rrBags 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. �azelton Avenue I lockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.socehd.com <br />