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1,44WIN c <br />tat SANAAQUIN <br />--COUNTY <br />Greatness qrnv.c hPre <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: 1-0-( <br /> <br />Lr <br />Premise Address: 5-75 v./ C7114,-,A4- <br />WP#: <br />Well#: <br />Soil Boring#: <br />Drilling Company: Ce....4 <br />Driller Onsite: --t. <br />Consultant: <br />Geologist: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular Seal Verified: CI Yes ENo <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />To: <br />To: <br />To: <br />To: <br />Public Water System Onsite: EYes ENo COMPLETION CI Stove Pipe El Christie Box <br /> <br />Domestic Well Onsite: E Yes ENo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />casing <br />height <br />ClALSTY-80X <br />COMPLET1CN <br />Ground Surfacs <br />Verified Chain of Custody: E Yes EN° <br />SPOILS <br />Contamination Noted: El Yes El N <br />If yes, spoils storage Location: <br />Covered: I=1 Yes ElNo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:? 1.54,i) 2..1-5*-1 _'f' <br />Depth to Water: q. <br />Grout Material: rvt.4.,As-- <br />Gallons of Grout Usechls-i-tai.),--N.8,4-tA"r rsyl <br />ElWell Installation Destruction <br />t1 /41M.4.1(,fi i emd1.1 1.1"d1 Filter Pack Type/Size: <br />Type of Method: <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />E Boring Installation El Boring Destruction <br />METHOD USED <br />EPressure Grout <br />CI Gravity <br />RI<Ier Drill <br />VK/ther: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Screen Feet <br />9 111 Iftt kr 7/ Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest 4 Bags Thickest Thinnest 4 Bags <br />2.5 s 1 5 10 1 <br />5 10 2 10 20 2 <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 79 7 <br />29 40 8 40 80 8 <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com