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4"°�° �_� SARDWOUIN <br /> �7 —COUNTY— <br /> Greatness <br /> Environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ' <br /> � Inspector: s�lke CONSTRUCTION <br /> Facility Address: _ �$o N 3guN ►jn►k . <br /> Well Address: 4J Total Depth: �� ( _ <br /> WP# Well#: Drilling Rig Type: 11 <br /> Soil Boring#: ��� ��, Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Nat- (OGtYt <br /> Screen Length From: To: <br /> Driller Onsite: Z.k <br /> Consultant: c Filter Pack From: To: <br /> Geologist: YMk S 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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING Aeove-GRouNo <br /> CHRHolding Temperature: � '�1ON CiOM�loN <br /> Method: G=nd Sudws <br /> Screening Method: alp <br /> Verified Chain of Custody: ❑ Yes El No —`---n' <br /> it. <br /> tt. <br /> SPOILS . <br /> >v <br /> Contamination Noted: ❑ Yes ❑No =" <br /> If yes, spoils storage Location: sbnad <br /> aeon = <br /> Covered: ❑ Yes El No _ g-w+Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: - 12,/ n• n' <br /> Grout Material: NW o,yrttll <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation�Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity �dTremie ❑Other: Type of Method: <br /> Water dement 4710 Water Cement 941b <br /> allons Bas eall ons Bags <br /> Thickest Thinnest ags Thickest Thinnest 1t Bags Bentonite/Cement 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 E 420 40 4 <br /> 12.5 25 5 25 SO 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.s*cehd.com <br />