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Iz SAN3J0A0UIN <br /> COUNTY Environmental Health Department <br /> °qe1FO �/ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: �i a CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: t 1 <br /> WP# 00L11 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: L ; Min 2" Annular EHD Seal Verified: 11 Yes []No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 1/l,0 Filter Pack From: To: <br /> Geologist: t Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑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: COWLETION COMPtETION <br /> Method: Ground Sud=* <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> ft. <br /> —ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: stoned = S <br /> on <br /> Covered: ❑ Yes ❑No _ vel <br /> If yes, material: /l� • S f <br /> grapack <br /> GROUTING or DESTRUCTION Tot I Depth: S =_ <br /> Depth to Water: '`� 4— n• tt' <br /> IF <br /> Grout Material: Q 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 Boring 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 /> GravityJremie ❑Other: Type of Method: <br /> Water /Ceme 471b water Cement 94 lb <br /> allons B 981111 ons Bags <br /> Thickest Thinnest 4 Bags Thickest Thinnest Bags 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 2.821 4.7 <br /> 7.5 15 1 3 15 30 3 <br /> 10 20 1 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 40 80 8 <br /> N 146 ql� 'J��} f 10/16/2017 <br /> 1868 E. Hazelton AvenuelI Sto ton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com <br />