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SANS 10AQUIN <br /> ( i K Environmental Health Department <br /> i —COUNTY— <br /> F+'C1CtiFOP��P/ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 15 0 Inspector: ea CONSTRUCTION <br /> Facility Address: :2' �Ir-e Qr (,M, <br /> Well Address: Total Depth: <br /> WP# �Q d �+}u Well#: Drilling Rig Type: <br /> Soil Boring#: VR)?, Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: _-T?-V(ArOn <br /> Driller Onsite: AnV�l� tAc e_� - <br /> Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLEr10N COMPLEnCN <br /> Method: G mnd Surface <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes El No <br /> it. <br /> it. <br /> SPOILS <br /> K. <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: s <br /> slotted <br /> sacdon <br /> Covered: ❑ Yes El No _ 1-v+pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: C. <br /> tt. = n. <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: �- n Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation�.Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> �- Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill �` ✓V Filter Pack Type/Size: <br /> >LGravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b water Cement 94 lb <br /> allons Bas allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 4Bags 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 /> 1 25 5 0 50 <br /> 155 3 <br /> 6 30 60 6 p1JlJ� <br /> 1 7 35 0 7 Lk�� <br /> 200 8 <br /> 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.s'cehd.com <br />