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SANcJ0A0UIN <br />—COUNTY— <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2?iI Inspector: ��► A. CONSTRUCTION <br />Facility Address:L� St, <br />Well A dress: Total Depth: <br />WP# 00 Ll -Z 2 Well#: Drilling Rig Type: <br />Soil Boring#:� aq Min 2" Annular EHD Seal Verified: <br />Drilling Company:' %-G4.-.1-4L-&h <br />❑ Yes []No <br />Driller Onsite: Screen Length From: To: <br />Consultant: pP-corn Filter Pack From: To: <br />Geologist: 6-11,173 Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />CIVAILTA190I\rel <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />Ch <br />height <br />AJ30VE-GROUND CAU S'iY430X <br />CONFLETION COMPLETION <br />Ground SLzla" <br />01 grout <br />ft. <br />tt. <br />ft. <br />M <br />— o <br />atoned <br />**Cron = B <br />I_ = pawl Pack <br />If yes, material: / <br />GROUTING or DESTRUCTION Total Depth: x2 <br />Depth to Water: no A� n - <br />Grout Material: <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />❑Boring Installation Boring Destruction <br />MFTWnn I KM <br />❑Pressure Grout ❑OvverrDrill <br />tDr <br />❑ Gravity XTremie / ❑ t0 her: <br />Water <br />allons <br />Cem nt 471b <br />Water <br />allons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />4 Bags <br />Thickest Thinnest <br />A Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <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 />ft. <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />l(0 b s <br />1868 E. Hazelton Avenue Stdckton, California 95205 T 209 468-3420 F 209 464-0138 <br />I I I <br />10/16/2017 <br />www.s*cehd.com <br />