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SANsIOAQUIN <br /> J —COUNTY Environmental Health Department <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �cl lkllnG Inspector: 1��_r�L,Sh kC4,%,\+k CONSTRUCTION <br /> Facility Address: <br /> Well Address: � A Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: L._ Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: S�C,iasd. 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: j height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: con,w�TION a+P1EnoN <br /> Method: Ground Sumacs <br /> Screening Method: arrcxA <br /> Verified Chain of Custody: ❑ Yes ❑No —`----n' <br /> n. <br /> —ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted <br /> B <br /> sattion — <br /> Covered: ❑ Yes ❑No g-vvl pack <br /> If yes, material: C <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: M n' <br /> Grout Material: 1\� �a �Qw�?,.� <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> ❑Boring Installation EIBoring Destruction Bags Slot Siziz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> rr Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie 00ther: �v�u 1G�1� Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest 9Bags 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 2.82 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 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.s*cehd.com <br />