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A <br /> ", CN <br /> �; X211 SAN.DIOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ? JE 2 v2z Inspector: S = -s- CONSTRUCTION <br /> Facility Address: yn2 Z►'iG1iewo0 <br /> Well Address: Total Depth: <br /> WP# ()()(40 23 Well#: Drilling Rig Type: <br /> Soil Boring#: 51 <br /> ' Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: ,"� Uj W <br /> Driller Onsite: ►�r�1 Screen Length From: To: <br /> Consultant: VJ C.(,` Filter Pack From: To: <br /> Geologist: W(AQi 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: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWP�1ON cCannPLEnON <br /> Method: G=nd Surf=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft. <br /> ft. <br /> ft. <br /> SPOILS ; <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: sbnad �; <br /> LK'JOn _°': <br /> Covered: El Yes ❑No <br /> = peva pack <br /> If yes, material: _ / <br /> GROUTING or DESTRUCTION Total Depth: D3/�� �� — <br /> Depth to Water: 2,p ft- ft' <br /> Grout Material: Neg Uiy�� <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> Gravity TTremie ❑Other: Type of Method: <br /> Water cement 4111 water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest 1t Bags Thickest Thinnest i7 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 /> 12.5 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 /> 1-j-11AY � t7 W 1 5"_1 Vv'gll l' 10/16/2017 <br /> 1868 E. Hazelton Avenue II Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />