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°U'"` S A N�d0 AU I N <br /> Q Environmental Health Department <br /> .. `f —COUNTY---- <br /> 4Oi�r °' Greutness grows here <br /> Monitoring�/We`,ll/Soil Boring Inspection Report <br /> + <br /> Date: 1 q 2 'L0 Inspector: niIISW &r✓ d-,-'L CONSTRUCTION <br /> Facility Address: <br /> Well Address: liu\ M c L�') Total Depth: � }/ <br /> WP# 0 Well#: Drilling Rig Type: T <br /> Soil Boring-# LA_ Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: ,� (�,^a, �e <br /> Driller Onsite: �,�> �, �� ;�,',�, 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 ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: CO�"��ION CC#AP EnCN <br /> Method: Ground Sumacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt. <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes, spoils storage Location: stoned <br /> a�c.on <br /> Covered: ❑ Yes El No = gr"w+P.-K <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: ��� " . <br /> Depth to Water: n• n' <br /> Grout Material: N: (,ll,-Altl <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 MBoring 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 N-Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest >1Bags 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 k 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 1 30 30 0 \ <br /> 17.. 7 7 7 5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />