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►Aur__. <br /> N SAN�,]0A0UIN Environmental Health Department <br /> COUNTY-- <br /> V'1�,toer' Greotness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 21 Inspector: P CONSTRUCTION <br /> Facility Address: Lp 0.Q 5• beArak <br /> Well Address: _ —"O;� e Total Depth: <br /> WP# Well#: Drilling Rig I-ype: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company:- Mt JAW. ak4\ -yen TQ 6111,(„ <br /> Driller Onsite: I Screen Length From: To: <br /> Consultant: . PSSO 0 P� <br /> Filter Pack From: To: <br /> Geologist: ISR Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING AWIVE-GROUND <br /> Holding Temperature: COt"��ION �t.EnCN <br /> Method: G=nd Surface <br /> Screening Method: or«a <br /> Verified Chain of Custody: ❑ Yes ❑No —n <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted <br /> socson = B <br /> Covered: ❑ Yes El No = gr.w+P.-k <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material:Wc,)r MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: a.G , 2G , 1(o . 14 <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation WBoring Destruction Bags iz 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 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest 9Bags 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 �5 20 v 2 1-- 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.s4cehd.com <br />