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SAW]OAQUIN <br /> COUNTY— <br /> Environmental Health Department <br /> — <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 3� Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: �� H <br /> WP# `'\\\ � L Well#: Drilling Rig Type: <br /> Soil Boring#: �?'-1– Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: �`�C(.,�A^ <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: N (s ScpT r'-Zo' S�(l vy c�Esj Filter Pack From: To: <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: *Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND __ <br /> Holding Temperature: COMPLETION COWLETioN <br /> Method: Ground Surface"+i <br /> Screening Method: groutgra <br /> Verified Chain of Custody: ❑ Yes EJ No �tt' <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes kN 0 <br /> If yes, spoils storage Location: slottad - s <br /> sac9on <br /> Covered: Yes ❑No gravel pack <br /> If yes, material: � 'fv\. Q t1,�1•!� <br /> GROUTING or DESTRUCTION Total Depth: 5'0 <br /> Depth to Water: ►J\� tt' <br /> Grout Material: Cs -1 <br /> Gallons of Grout Used: SS ad� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> EJ Boring Installation�]Boring Destruction Slot Size: <br /> \\ 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 tremie ❑Other: Type of Method: <br /> Water (Cement 471b water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest PBags Thickest Thinnest 9Bags 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 4 20 40 4 <br /> 12.5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 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 />