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SAN ,)OAQ U I N Environmental Health Department <br /> COUNTY <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 0 Inspector: r W!!!:� CONSTRUCTION •� _ <br /> Premise Address: <br /> WP#: 00 ft?--/ Total Depth: 00 <br /> Well#: vi lk t3 Drilling Rig Type: ry3y6!.,/1 <br /> Soil Boring#: Min 2"Annular Seal Verified: C9 Yes ❑No <br /> Drilling Company: <br /> /1 Screen Length From: 090 To: t 8,5' <br /> Driller Onsite: rsn. itTo: t u <br /> Consultant: CTtnSav,�c�, <br /> / Filter Pack From: <br /> Geologist: Ca„�,,,,N-e.., Bentonite From: fCo To: PSS <br /> Grout From: To: IFC) <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: COAPLETION COMPtEMN <br /> Method: G=nd Surface <br /> Screening Method: gf«n <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> ft. <br /> ft. <br /> SPOILS = <br /> e <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: cloned _ 3 <br /> — <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_ <br /> Depth to Water: n• tt. <br /> Grout Material: ✓fit. " <br /> Gallons of Grout Used: � MATERIALS/DEVELOPMENT <br /> Casing Type: S{v....'k-CS S -' l <br /> 27 Well Installation ❑Well Destruction Blank w3 Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: 411 S rXS- tot,11., t2 Sb 1S <br /> Type/Brand of Bentonite: q S.sem r� 0 if <br /> ❑Pressure Grout Drill Filter Pack Type/Size: <br /> El Gravity LYTremie ❑Other: Type of Method: <br /> �►�.S 4D,,— <br /> Water Cement 471b Water Cement 941b wwy <br /> allons Bags zallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags <br /> 2.5 s 1 s 10 1 Bentonite/Cement Mix 3% Mix 5% Mix <br /> 5 10 2 10 20 2 Bentonite per 47 Ib 1.41 2.47 <br /> 7.5 is 3 1s 30 3 <br /> 10 20 4 20 40 4 Bentonite per 94 Ib 2.82 4.7 <br /> 1is 30 6 30 60 6 <br /> 7.5 35 7 35 70 7Cl 411 40 <br /> 20 40 8 40 BO 8 /7 <br /> 1868 E. Hazelton Avenue I StoLkton, California 95205 1 T 209 468-3420 1 F 209 4x6244---0138 1 www.sjcehd.com <br /> 11 "Ic1b `��LS14VltvP Wtv `�1 N �!°5 K� .►�11 <br />