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SANPJ0A0UIN Environmental Health Department <br /> COUNTY— <br /> ��,�k �i Greatness grows here. <br /> C <br /> Monitoring <br /> Well/Soil Boring Inspection Report <br /> Date: ZJ p Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Addre.-­ Total Depth: <br /> WP#ib q0 qv Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> � S D►r�'(I� Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: tsC t C- Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes E]No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: lFiLTT height <br /> R ff__ —Crw–f <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CO tPLE ION CC#APLEnoN <br /> Method: Ground Surface <br /> Screening Method: grocrt <br /> Verified Chain of Custody: ❑ Yes El No 4r n. <br /> tt. <br /> n. <br /> SPOILS <br /> x = a <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: slotted <br /> sacion _ <br /> Covered: ❑ Yes ❑No = �„ <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> IF <br /> Depth to Water: _1 n' n' <br /> Grout Material: �tsti � �Q Y^ L 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 of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> [Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47 lb water Cement 941b <br /> gall s Bas gallons Bags <br /> Thickest Thinnest aBags Thickest Thinnest 11Bags Bentonite/Cement Mix 3% Mix 3% 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 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> M 4 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 />