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SAN 10AQUIN <br />-- <br />COUNTY <br />Greutness grows here. <br />292 <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 07120ZIInspector: <br />From: <br />1 � <br />Facility Ad ress: <br />�M RP <br />ck r <br />Well Address: <br />From: <br />To: <br />WP# 00 q ZZ(o 3 <br />From: <br />Well#: <br />Soil Boring#: CK3 I <br />LF`F2 <br />10 <br />Drilling Company: 0 <br />ddle F r <br />C-t60426h <br />Driller Onsite: <br />, <br />20 <br />Consultant: Mi <br />Pag4C C5� <br />1r)-er t2�7 <br />Geologist: Pmts. <br />15 <br />30 <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />CONSTRUCTION <br />Total Depth:_ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height . WT <br />ABOVE -GROUND C -lRl! Y -BOX <br />COMPLETION COMPLETION <br />Ground surface <br />grout <br />it. <br />ft. _ <br />K. <br />= e <br />_ o <br />slotted <br />seedon <br />9-1pack <br />GROUTING or DESTRUCTION Total Depth: _i) –. � 4/ ( t <br />Depth to Water: -4 G' tL 2 r— tt- <br />Grout Material: MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />❑Boring Installation WBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity XTremie ❑Other: _ <br />\� Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />bBags <br />2.5 <br />5 <br />1 ✓ <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 V <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 ✓ <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 3% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <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 />