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°`""` • SAN�10AgUIN <br /> Environmental Health Department <br /> —COUNTY- <br /> 0� Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: inspector:Inspector: K.SaeieYn CONSTRUCTION <br /> Facility Address:456b b Y" '- Ca V; ;rlt r1F6 _ <br /> Well Address: Total Depth: Or <br /> WP#_pi4UWell#: Drilling Rig Type: 1), en Mu6 (`o rGrU <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes E]No <br /> Drilling Company: Cla;t\P. lnle\\ Yi L <br /> Driller Onsite: Q_et-cae\ Screen Length From: To: <br /> colt,III11I1]1: Filter Pack From: To: <br /> Geologist: 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-GIRCUND <br /> Holding Temperature: COWPLETION compLtnoN <br /> Method: csro nd Suri. —" <br /> Screening Method: provt <br /> Verified Chain of Custody: ❑ Yes 11 No <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> stoned <br /> sac'on -- <br /> Covered: ❑ Yes ❑No <br /> If yes, material: — <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: ft• " ` ft• <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑BSlot Size: <br /> oring Installation ❑Boring 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 ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water ment 941b <br /> allons Bas Rall ons Bags <br /> Thickest Thinnest sBags Thickest Thinnest a s Bentonite/Gement 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 /> 2� bays r)eaT cernz<- r 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 www.s4cehd.com <br />