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W'~ SANst,J0A0UIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 3_3t_Z0Inspector: rr��,;45�, L'�y� �2. CONSTRUCTION <br /> Facility Address:4A Al:Is ditl5l' letlee <br /> Well Address: Total Depth: <br /> WP# rc qc*� Well#: Drilling Rig Type: ( �'� <br /> Soil Boring#: 2�' �-� <br /> Drilling Company: CG��s - �x Min 2"Annular EHD Seal Verified: ❑ Yes 11 No <br /> Driller Onsite: k Screen Length From: To: <br /> x'1,4 rn�y Filter Pack From: To: <br /> Consultant: <br /> Geologist: •�q� <br /> 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 AOVE-GRCUND <br /> Holding Temperature: COWLETiON CVAPLEMN <br /> Method: Ground Surface <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes El No —`--n• <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No — <br /> C <br /> If yes,spoils storage Location: stoned _ - <br /> s�on — <br /> Covered: ❑ Yes El No = gravel Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: c k <br /> Depth to Water: '(�"1 E n• n' <br /> Grout Material: ,!{,,L MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation 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 tJTremie ❑Other: Type of Method: <br /> atey meat 471b Water Cement 94lb <br /> 23 ons ogs gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 3%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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.socehd.com <br />