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SAN910A0UIN <br /> Environmer,Lal Health Department <br /> —COUNTY— <br /> \��q< Greatness grows here. Afti*P- , $;30 <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: W Inspector: 511 I\Vl CONSTRUCTION <br /> Facility Address: q3'A k&yY kt\ IUEV�Y" k-1ncl � <br /> Well Address: Total Depth: <br /> WP# Well#_wTq Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: c s "Yviq;' <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: _ W OA N" Filter Pack From: To: <br /> Geologist: J 1 Yy\ 1ekLtder 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 El No --��r-- casing <br /> T <br /> If yes, location and distance: I height I WT <br /> SAMPLING Of K ABOVE-GROUND <br /> Holding Temperature: COMPLETION COMPLEMN <br /> Method: G3rwnd S`wf"' <br /> Screening Method: groLn <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> SPOILS Nip,, <br /> ft. <br /> Contamination Noted: ❑ Yes ❑NoAl <br /> If yes, spoils storage Location: atonad M <br /> sac�on <br /> Covered: ❑ Yes ❑No = g,,,W Pack <br /> If yes, material: rL <br /> GROUTING or DESTRUCTION Total Depth: y. <br /> Depth to Water: s\ P-�- —ft. tt. <br /> Grout Material:��� �, <br /> Gallons of Grout Used: "I' MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Blank Feet Screen Feet <br /> ❑Boring Installation [ Slot Size: <br /> Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ;,Tremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest 1t Bags Thickest Thinnest aBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 /> 00,E 1 b C'�k1 900--55 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.secehd.com <br />