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SANAOAQUIN <br /> —COUNTY Environmental Health Department <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 3 Inspector: CONSTRUCTION <br /> Facility Address: k6ur(j (5 <br /> Well Address: Total Depth: <br /> WP# no g1o36 Well#: Drilling Rig Type: CP7 <br /> Soil Boring#: - T <br /> Drilling Company: l�i ►�f� �� Min 2"Annular EHD Seal Verified: El Yes []No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: �3Sk 4OGu Filter Pack From: To: <br /> inu�f-1 a,,— Bentonite From: To: <br /> Geologist: Be <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 0N COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING Asove.cRCUNO CHM_ <br /> Holding Temperature: CONFLETION ccc*APLenoN <br /> Method: Ground Surface <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> ft. <br /> tt. <br /> SPOILS <br /> o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: slatted <br /> soon r <br /> Covered: ❑ Yes ❑No <br /> g­w Pack <br /> If yes, material: ' <br /> GROUTING or DESTRUCTI QN Total Depth: 4-. =_ <br /> Depth to Water: Z77- t<. % n' <br /> Grout Material: �Lewf'' 60,Y tA-f— <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation NBoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity 14Tremie ❑Other: Type of Method: <br /> Water eement Water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest age Thickest Thinnest tJBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 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 1 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.s'cehd.com <br />