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SANSTJ0A0UIN <br /> {� 'j --COUNTY- Environmental Health Department <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: 1l CONSTRUCTION <br /> Facility Acl res : 15 ( N• 1 n <br /> Well Address _QSZ�{� Total Depth: <br /> WP# 0CA1q!� Well#: Drilling Rig Type: <br /> Soil Boring#: 94 Min 2"Annular EHD Seal Verified: El Yes []NoDrilling Company: COrI <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 ABOVEGROUND _ <br /> Holding Temperature: COkFLE ION CC#APLEncN <br /> Method: Ground Surta:. <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �ft• <br /> h. <br /> ft. <br /> SPOILS . =_ <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: <br /> abttne _ � <br /> section = B <br /> Covered: ❑ Yes ❑No _ i_w+>ac* <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: : <br /> Depth to Water: r t<• <br /> Grout Material: NPQ. C('>" ny MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 15 WIN <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction abaq-) Blank Feet Screen Feet <br /> rjG\ Slot Size: <br /> ❑Boring Installation ❑Boring Destruction ` s Bags of Cement: <br /> METHOD USED wa' Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> KGravity Fremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest 1t Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix S%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 1530 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 B 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />