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SAN 10AQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> v-70 Monitoring Well/Soil Boring Inspection Report <br /> Date: �Inspector: 6-.-- L,- CONSTRUCTION <br /> FacilityAddress: Z Al C C 10l ✓f— <br /> Well Address: Total Depth: ",,d <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: — <br /> Soil <br /> Company: r-'9- Min 2"Annular EHD Seal Verified: El Yes El No <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: HIC111 e-V i A i ds G Filter Pack From: To: <br /> Geologist: 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 c w LEncN <br /> Method: G=nd Su faen <br /> Screening Method: afOt't <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted = - <br /> n <br /> Covered: ❑ Yes ❑NoZr, _ <br /> pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n, tt. Ate. <br /> Grout Material: ECILU411,1P <br /> Gallons of Grout Used: �- Q A,�„� MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation`Aoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity 'OTremie ❑Other: Type of Method: <br /> Water Cemen 71b Water Cement 941b <br /> allons Ba allons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest ABags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 1 40 80 8 <br /> L aI I r2 lob'S 10/16/2017 <br /> 1868 E. Ha9elton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />