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uip o� <br /> SAN MAQUIN Environmental Health Department <br /> - COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: 2B_Z 1dfl-0— <br /> Well Address: Total Depth: <br /> WP# M%51 Well#: Drilling Rig Type: <br /> Soil Boring#: �)\ Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 1 <br /> Driller Onsite: � �Gi� Screen Length From: To: <br /> Consultant: Gl C i� J Filter Pack From: To: <br /> Geologist: L r Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ED 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: COWP�nON c�tFncN <br /> Method: Ground Surface <br /> Screening Method: et(Xn <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> tt. <br /> ft. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes 171 No — <br /> If yes, spoils storage Location: slonad _ -e <br /> axon <br /> Covered: ❑ Yes []No = graw+P_* <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: �?_)o <br /> Depth to Water: no ( n• n' <br /> Grout Material: nNLk c_rq^ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 40 <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation IRBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> 0-Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest aBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 3% 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 /> is 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 1 70 7 <br /> 20 40 8 40 1 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 />