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• °a'"�' SAN 10AQUIN <br /> Environmental Health Department <br /> COUNTY- <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 02 Inspector: CONSTRUCTION <br /> Facility ddress: 2 V I'O&A► - 0 <br /> Well Address: Total Depth: CPT <br /> WP# DLJ Well#: Drilling Rig Type: <br /> Soil Boring#: LF C) 54 CE —2G--1__� <br /> Drilling Company: Min 2" Annular EHD Seal Verified: El Yes El No <br /> Screen Length From: To: <br /> Driller Onsite: Ni(_ <br /> Consultant: � � Filter Pack From: To: <br /> Geologist: 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 El No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND CHRLSTY_ <br /> Holding Temperature: COMFLE ION COOMPIXMN <br /> Method: Ground 5urlwo <br /> Screening Method: groLA <br /> Verified Chain of Custody: ❑ Yes El No -�—n• <br /> fi. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: sbnad <br /> .on — B <br /> Covered: ❑ Yes El No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: . =_ <br /> Depth to Water: V n. tt. <br /> Grout Material: Neat- p. MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation(� Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity Premie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bagallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 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 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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />