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u .�,_,� SAN—COUNTY N Environmental Health Department <br /> �.��,��a`.• Greotness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ��9�1 Inspector: �rNft�W' CONSTRUCTION <br /> Facility Address: <br /> Well Address: _1k21 AA e-GovAk,,.e, . G.1-oC,�*�tn Total Depth: �� <br /> WP#__Qd 440 6'i Well#: Drilling Rig Type: 1-t'l cle! <br /> Soil Boring#: Vi5N_15%) <br /> + Min 2"Annular EHD Seal Verified: El Yes []No <br /> Drilling Company ASL wt,(( Ab,,,Ue, k.••..l <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 ❑No casing <br /> If yes, location and distance: im height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION cCOMPLEnON <br /> Method: Ground Surface <br /> Screening Method: Oran <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> n. <br /> it. <br /> SPOILS w <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: stoned <br /> soon <br /> Covered: ❑ Yes ❑No _ enw+aack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: _ <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation �oring 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 ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest J1 Bags 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 25 50 5 <br /> 15 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 Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 www.slcehd.com <br />