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,puin,c <br /> SAN 7-10AQUIN Environmental Health Department <br /> I` <br /> --COUNTY-- <br /> ��0��, P' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: t Inspector: CONSTRUCTION <br /> FaciIityAddress: M C4c.1v- o - UJe <br /> Well Address: U Total Depth: <br /> WP# Well Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: C Screen Length From: To: <br /> Consultant: 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: height <br /> —ef W7:F <br /> SAMPLING /ABOVE-GROUND <br /> Holding Temperature: COWP ETION c�t.snoN <br /> Method: Ground Surfaes <br /> Screening Method: arm <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes,spoils storage Location: abnad <br /> an <br /> Covered: ❑ Yes ❑No = VW <br /> pacic <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n• n' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Q ��Q( Blank Feet Screen Feet <br /> n Slot Size: <br /> ❑Boring Installationieoring Destruction J�S Bags of Cement: <br /> METHOD USED I/ I z �� Q�y/ Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest trBags Thickest Thinnest tlBags 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 /> 35 7 35 70 7 <br /> 2� 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />