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SAN�JOA UIN <br /> Environmental Health Department <br /> j' <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:-7Z7 --)Ar Inspector: Q'1';A-- A CONSTRUCTION <br /> Facility Address: 5 !2Q <br /> Well Address: Total Depth: <br /> WP# 00 goSS I Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Driller Onsite: fl'P— Screen Length From: To: <br /> Consultant: --S1iQ GZ uk , S pun Filter Pack From: To: <br /> Geologist: —R&O 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: COW�TION cc#APLEncN <br /> Method: Ground Surlacy <br /> Screening Method: ori <br /> Verified Chain of Custody: ❑ Yes []No -�--n' <br /> n. <br /> ft. <br /> SPOILS =_ <br /> Contamination Noted: ❑ Yes El No r` <br /> If yes, spoils storage Location: atottad <br /> s*clon a <br /> Covered: ❑ Yes ❑No y = g-w-WPack <br /> If yes, material: L <br /> GROUTING or DESTRUCTION Total Depth: �S 7 (?C�� <br /> Depth to Water: ,0 n- n' <br /> Grout Material:_6 .eA MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: e✓d 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 /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cemen 471b Water Cement 94 lb <br /> allons Bas gallons BaRs <br /> Thickest Thinnest ttBags Thickest Thinnest uBags 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 z 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 1s 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 a 40 e0 s <br /> I S 10/16/2017 <br /> 1868. Hazelton Avenue Stockton California 95205 T 209 468-3420 F 209 464-0138 www.s'cehd.com <br /> I I I I � <br />