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,6$,G A,c <br /> ', SANs10AQUIN Environmental Health Department <br /> COUNTY <br /> tw,tP Greatness grows here. <br /> 77,,�� <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: t (� �ZO Inspector: \ I CONSTRUCTION <br /> Facility Ad ress: L f )LlF1/i� ovj <br /> Well Address: �_ �j Total Depth: <br /> WP# 001A ) 7"l 0 S Well#: Drilling Rig Type: <br /> Soil Boring#: 2 <br /> Drilling Company: I � "— Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: Anoi I Screen Length From: To: <br /> Consultant: A -Qr& K Filter Pack From: To: <br /> Geologist: !� ` r i Bentonite From: To: <br /> Ist: �LR'� 1:-�U�� f � <br /> Grout From: To: <br /> — <br /> Public Water System Onsite: ❑ Yes E]No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> —CWT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: C06FLHTION cCCMPIEnON <br /> Method: Ground Surf=* <br /> Screening Method: gtout <br /> Verified Chain of Custody: ❑ Yes [I No �ft' <br /> tt. <br /> ft. <br /> SPOILS 4. <br /> Contamination Noted: ❑ Yes ❑No =" _ <br /> If yes, spoils storage Location: atoned <br /> on <br /> Covered: ElYes ❑Nograviol Packf <br /> If yes, material: _= <br /> GROUTING or DESTRUCTION Total Depth: /Z00— _ <br /> _ <br /> Depth to Water: F+ n- n' <br /> Grout Material: n1 MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: _ <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction �� ,,;�+ Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction U Slot Size: <br /> ( � Bags of Cement: <br /> METHOD USED �� Bags Sand/Gravel: <br /> D Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill v'=, '�• Filter Pack Type/Size: <br /> ❑ Gravity NTremie ❑Other: b Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest 0Bags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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.secehd.com <br />