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"°u'"c SANr10ANIN <br /> ��-"� Environmental Health Department <br /> —COUNTY— <br /> c9rr.' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: \A ) a) inspector% Sat l 6 <br /> 1. CONSTRUCTION <br /> Facility Ad (0)(A f L Q <br /> Well Address: _ __ _ Total Depth: <br /> WP# O(1�-1 i LA 0 Well#: Drilling Rig Type: <br /> Soil Boring#: Iffi <br /> Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company:- U.; 1� ilt <br /> nG Screen Length From: To: <br /> Driller Onsite: R <br /> Consultant: r Filter Pack From: To: <br /> Geologist: 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 ❑No --_ casing <br /> If yes, location and distance: I height <br /> SAMPLING ABOVE-GRCUNp <br /> Holding Temperature: COWPLETION 00MPotii <br /> Method: Ground Surf"' <br /> Screening Method: Qrout <br /> Verified Chain of Custody: ❑ Yes El No �ft• <br /> n. <br /> tt. <br /> SPOILS <br /> _ - <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted <br /> section <br /> Covered: ❑ Yes ❑No = g—W <br /> If yes, material: Pack <br /> GROUTING or DESTRUCTION Total Depth:_ <br /> Depth to Water: n• n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: d <br /> _ Casing Type: <br /> ❑Well Installation ❑Well Destruction �SBlank Feet Screen Feet <br /> ' Slot Size: <br /> ❑Baring Installation LBoring Destruction b� Bags of Cement: <br /> METHOD USED ;� Bags Sand/Gravel: <br /> �� Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill L Aq <br /> ,y. Filter Pack Type/Size: <br /> ❑ Gravity i8lremie ❑Other: Type of Method: <br /> Water Cemen '471b Water Cement 941b <br /> allons Bas eallons Ba s <br /> Thickest Thinnest NBags Thickest Thinnest J1 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 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.sacehd.com <br />