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ully <br /> Z°" � SANAOAQUIN <br /> _COUNTY <br /> Environmental Health Department <br /> ) <br /> °� <br /> kip� P'! Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: �gj Qn„,�� '� 1n,1u;-•r 4>:y1 S6l , <br /> Well Address: Total Depth: <br /> WP# �)0 yy�� ( Well#: �S1�o Drilling Rig Type: <br /> Soil Boring#: %_r� Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: R,.."ems k�.j1A 1 AE ;:,. Screen Length From: To: <br /> Driller Onsite: <br /> c <br /> Consultant: � Filter Pack From: To:�p/;�,�;,r��o.� <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> iii <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: Ground Surface <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes El No -it' <br /> 16 <br /> it. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No >' _ <br /> If yes, spoils storage Location: abtted <br /> sacdon <br /> Covered: ❑ Yes ❑No = Gravel l <br /> ack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: __ <br /> IF <br /> Depth to Water: tL tt' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction gags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity gTremie ❑Other: Type of Method: <br /> Water Cern 71b1 Water Cement 941b <br /> allons Bae gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest NBags 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. Hazelf"on Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />