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SAN.PIOAQUIN <br /> Environmental Health Department <br /> _ <br /> COUNTY— <br /> �, �/� Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: i0lt?t7cY ,� Inspector: A CONSTRUCTION <br /> Facility Address: (541 Ati3Ok4 wt._.,, MB4r, <br /> Well Address: �r Total Depth: <br /> WP# (9E, gIg,C%9 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> ��u (���.r,tr Min 2" Annular EHD Seal Verified: El Yes EI No <br /> Drilling Company: �, <br /> —, Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: CA',d„y J;�AC <br /> Filter Pack From: To: <br /> Geologist: /tel 4t'61 ffe Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes 1:1 No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CO&FLETION compt.EnON <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No -�--n' <br /> tt. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted <br /> sac�on y'• __ B <br /> Covered: ❑ Yes ❑No <br /> gawt pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 544 __ <br /> Depth to Water: fL n' <br /> Grout Material: Al 1_:L <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 PdBoring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bags eallons Bags <br /> Thickest Thinnest xBags Thickest Thinnest BBags 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 /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 1 30 6 30 60 6 <br /> 17.5 1 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.shcehd.com <br />