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SAN-J0A0UIN <br /> Environmental Health Department <br /> COUNTY-- <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: O 2 Q Inspector: Sul-Arwx CONSTRUCTION <br /> Facility Address: o ct �. I <br /> Well Address: i IF Total Depth: S <br /> WP# Oaf 0y/ Well#: Drilling Rig Type: S u� <br /> Soil Boring#: 91. <br /> Drilling Company: d'PL, � Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> yy <br /> Driller Onsite: SIM, Screen Length From: To: <br /> Consultant: P/S1�L Filter Pack From: To: <br /> Geologist:_= G�1 'C!/I/� 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 El No casing <br /> If yes, location and distance: IT height <br /> — 59 <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLErt°N c�tFnoN <br /> Method: G=n°S`xf"' <br /> Screening Method: graA <br /> Verified Chain of Custody: ❑ Yes El No —ft. <br /> tt. <br /> SPOILS tt. <br /> aZ <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: <br /> slotted <br /> soclon <br /> Covered: ❑ Yes ONO <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_ <br /> Depth to Water: "Z tt- tt. <br /> Grout Material: lye d (4",v( <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 Boring Destruction 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 Vrremie ❑Other: Type of Method: <br /> Water mOf471b Water Cement 94 lb <br /> allons Bas zallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest t+Bags 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 30 3 <br /> 10 2 W 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> IS 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 952051 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />