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SAN�J0A0UIN <br /> Environmental Health Department <br /> COUNTY- <br /> �;�, �/ Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 0 2U 2 Inspector: SrJ�1 nG 5 CONSTRUCTION <br /> Facility Address: 2k1�G G 9--m—r- 9-d. <br /> Well Address: &ACL kOn Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: mg-av\ 4n Q(,IGI STnC. <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: 1LC(►.�Lln `ii ASSO(IahaS Filter Pack From: To: <br /> Geologist: 1KJGi,V_ 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 ABOVE-GROUND <br /> Holding Temperature: COMPLETION c _oMPLEnoN <br /> Method: Ground Sudw* <br /> Screening Method: arl«rt a <br /> Verified Chain of Custody: ElYes El No •3---n: �4- <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = s <br /> If yes,spoils storage Location: _ 2 , <br /> slatted _ <br /> Covered: El Yes ❑No g.�+P..* <br /> If yes, material: = °n 0) <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: <br /> ��� <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> ��. Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> El Boring Installation [Boring Destruction Slot Size: <br /> b Bags of Cement: <br /> METHOD USED ``3,� Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill k'J 1J Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas eallons Bags <br /> Thickest Thinnest aBags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix S%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 V 15 30 3 <br /> 10 20 4 ✓ 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 t/ 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.secehd.com <br />