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SAN910AQUIN <br /> EnvironmenLal Health Department <br /> J COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Z$ 1AZI InspectorrD r A CONSTRUCTION <br /> Facility Address: 12.050 �. F✓P.IYtD0 5f, r <br /> Well Address: ct Total Depth: <br /> WP# (00 Li I(* l 3 Well#: =W Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: r r ( V! <br /> Screen Length From: To: <br /> Driller Onsite: I <br /> Filter Pack From: To: <br /> Consultant: AAv0-,-v(.zj 6eo Bentonite From: To: <br /> Geologist: GVD-V► <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No caging <br /> If yes, location and distance: height <br /> .WT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COiPLETION COMPLETION <br /> Method: Ground Sri"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt. <br /> tt. <br /> tt. <br /> SPOILS <br /> v1 C <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes,spoils storage Location: sio <br /> nad <br /> soon = 2 <br /> Covered: ElYes ❑No LO <br /> If yes, material: <br /> GROUTING or DESTRUCTION Tot I Depth: <br /> Depth to Water: ^ tt• y tt' <br /> Grout Material: e` MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 0— <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> El Pressure Grou X"Over Drill Filter Pack Type/Size: <br /> ❑ Gravity gITrem ❑Other: Type of Method: <br /> Water Cement 71b Water Cement 941b <br /> allons Bas eall ons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest uBags Bentonite/Cement Mix 3% Mix 5a/ <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 .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 /> 3 o q q 6 ba S 10/16/2017 <br /> 1868 E. Hazelton Avenue StIton California 95205 T 209 468-3420 F 209 464-0138 www.s'cehd.com <br /> I I I I l <br />