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SANi10A0UIN <br /> Environmental Health Department <br /> —COUNTY <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: YC0.n��Sw 6'(Z,L CONSTRUCTION <br /> Facility Address: <br /> Well Address: \\U L�VoTotal Depth: d"I <br /> WP# (,)j L�r�+`L Well#: Drilling Rig Type: Adz-'-t' E� <br /> Soil Bo�#: Min 2"Annular EHD Seal Verified: ❑ Yes 11 No <br /> Drilling Company:ABs aL 0 <br /> Screen Length From: To: <br /> Driller Onsite: <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.GaouNo <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: Ci=ndScafacs + <br /> Screening Method: c� <br /> Verified Chain of Custody: ❑ Yes El No n <br /> it. <br /> tt. <br /> SPOILS -_ <br /> Contamination Noted: ❑ Yes ❑No ` <br /> If yes, spoils storage Location: stance - <br /> tac�on 4 = B <br /> Covered: El Yes El No <br /> = g-,w <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: o <br /> Depth to Water: M n' <br /> Grout Material: Alt,L ( ,o•u-�n�- <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 <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 gallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest ttBags 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 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 F40 80 8 <br /> ��� 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />