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(�P g SAN:,)OAQUIN Environmental Health Department <br /> { <br /> ` COUNTY- <br /> �O�c,Fopr,`' Greatness grows here. <br /> ((��,, Monitoring Well/Soil Boring Inspection Report <br /> U <br /> Date: 6104 Inspector: rV-1 CONSTRUCTION <br /> Facility Address: 5 <br /> Well Address: Total Depth: <br /> WP# DLII b Iq Well#: Drilling Rig Type: CPT <br /> Soil Boring#: <br /> �,(� �G � Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller Onsite: Ami <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> _CWT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLErlON ccOOMPLEMN <br /> Method: Ground SLeaos '+'".� <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes El No —n' <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes,spoils storage Location: slotted <br /> soon — <br /> Covered: ❑ Yes ❑No = gra„all pacK <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: _ <br /> w <br /> Depth to Water: n- tt' <br /> Grout Material: lar C"U"4-jt 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 <br /> Filter Pack Type/Size: <br /> ❑ Gravity )Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> gall s Bas gallons Bags <br /> Thickest Thin st 8Ba s Thickest Thinnest "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 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.s4cehd.com <br />