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Nc•, <br /> SA N�J 0 A 0 U I N Environmental Health Department <br /> oriw" - -COUNTY- - <br /> t/ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> t oar I <br /> Date: Inspector: IiL 74• CONSTRUCTION <br /> Facility Address: 02 (/_ <br /> Well Address: Total Depth: S A I I <br /> WP# 009_l oZ S (7 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> l- Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: 0.- Filter Pack From: To: <br /> Geologist: bn 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 casing <br /> If yes, location and distance: height <br /> —aw, <br /> SAMPLINGAWVE-GgpUNp <br /> Holding Temperature: COMPLfi710N con+�tEMN <br /> Method: Ground Suiacs <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes El No �n. <br /> • � � n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No 2 I Q <br /> If yes, spoils storage Location: 1 stotWd <br /> &*Cyon 4- <br /> Covered: ❑ Yes ❑No _ <br /> If yes, material: L <br /> 9—W Pack <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 4 n• n <br /> Grout Material: <br /> Gallons of Grout Used: �� o✓ MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ,�,_/ Slot Size: <br /> ❑Boring Installation L�Boring Destruction Bags of Cement: <br /> METHOD USED / Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> 1/-Gravity ❑Other: Type of Method: <br /> Water Cement 71b Water Cement 941b <br /> allons Bas otall ons Bags <br /> Thickest Thinnest uBags Thickest Thinnest ttBags 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 /> 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 /> ^�3 / a I l a CJ a ( 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stodkton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s'cehd.com <br />