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SANdOAQUINp <br /> Environmental Health Department <br /> `J <br /> COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> i <br /> Date: 1 k uzu Inspector: ` CONSTRUCTION <br /> Facility Address: \(.o 'Z8C �.`X c; c�.T <br /> Well Address: Total Depth: <br /> WP# f XA\U'11A Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> -� � Min 2"Annular EHD Seal Verified: El Yes []NoDrilling Company: \1 4 <br /> Driller Onsite: 36to Screen Length From: To: <br /> Consultant: an c <br /> Filter Pack From: To: <br /> Geologist: ��teh <br /> 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 —r— casing <br /> If yes, location and distance: T height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: G=nd Surface <br /> Screening Method: or«rt <br /> Verified Chain of Custody: ❑ Yes El No �tt' <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stottad <br /> aeon <br /> Covered: ❑ Yes ❑No = s <br /> ack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: i�'�. <br /> Depth to Water:_fie, <br /> Grout Material ( !. \ <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Boring Installation ®,Boring Destruction � <br /> ❑ C/ Slot Size: <br /> ��� \ Bags of Cement: <br /> METHOD USED �2� ' Bags Sand/Gravel: <br /> Clz���� 0, Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill G<)� I Filter Pack Type/Size: <br /> ❑ Gravity ATremie ❑Other: Y`Q�� '� Type of Method: <br /> Water Cement 471b Water Cement 94 lb N` ' <br /> allons Bas vallons Bas <br /> Thickest Thinnest 1t Bags Thickest Thinnest b Bags 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 1 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 />