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°- SAN LL,JOAQUNTYUIN <br /> u� a _COEnvironmental Health Department <br /> --- <br /> `4uFOR•+;P' G-eotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: 9(01ry CONSTRUCTION <br /> Facility Address: cvlKLSV►A'In' go/ <br /> Well Address: Total Depth: 0 <br /> WP# 0 O 4n R 15- Well#: Drilling Rig Type: <br /> Soil Boring#: 91 . g7 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: '(�O�tJj Screen Length From: To: <br /> Consultant: F 0U <br /> Filter Pack From: To: <br /> Geologist: �bS1v 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: Iff height <br /> SAMPLING ABOVE-GROUND CHR_ <br /> Holding Temperature: CON PLETION cOMPLEnoN <br /> Method: Ground Sumacs + <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: slotted = B <br /> asc.on ' <br /> Covered: ❑ Yes ❑No - gravel Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: / ft• ft' <br /> Grout Material: f <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation)f Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity YTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest IBags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 1 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 80 8 <br /> f baht WI/- 0 OQN w 4v 9a-e- 47 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />