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SAN,,�J0A U1N <br />Q Environmental Health Department <br />—COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 0 1 Inspector: CONSTRUCTION <br />Facility Address: -N� \kVKx �Xw e I <br />Well Address: 'Sod Total Depth: <br />WP# u0,�Dbl, Well#: Drilling Rig Type: <br />Soil Boring#: ("�Z'C -�..� 1D ,� , \'O . t\\ \Z <br />l AN ti C (Cit. Min 2" Annular EHD Seal Verified: El Yes 1:1 No <br />Drilling Company: <br />Driller Onsite: �` P�`-'� Co Screen Length <br />From: <br />To: <br />Consultant:Filter Pack <br />From: <br />To: <br />Geologist: Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <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 />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />VJ Yes <br />❑ Yes <br />❑ Yes ❑No <br />❑ Yes XN 0 <br />❑ Yes []No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation V�Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity Aremie ❑Other: <br />Water <br />gallons <br />Cement 47 lb <br />Bas <br />I <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12,5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />1 40 <br />80 <br />8 <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />AMOVE.GROUND cHRssy-sox <br />CONPLEr N COMPLETION <br />Ground Swfacs <br />grout <br />ft. <br />tt. <br />ft. _ <br />= o <br />zlattad a = =g <br />sac5on <br />= tmval Pack <br />ft. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank` Feet <br />Slot Size: <br />Bags of �ement: <br />Bags San /Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <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 />E <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.slcehd.com <br />