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Environmeftl Health Department <br />Monitoring Well/Soil Boring Inspection Reporl <br />Date: Inspector: 9144 0;-A-"l-'0�vA CONSTRUCTION <br />Facility Address: d yA y y- 44 v—. X R-1, <br />Well Address: STotal Depth: <br />WP# Od ax Well#: I'�W—jf� Drilling Rig Type: <br />Soil Boring#: <br />Min 2" Annular EHD Seal Verified: <br />Drilling Company: ^-84 Screen Length From: <br />Driller Onsite: /V.O,- <br />Consultant: SPT / M Filter Pack From: <br />Geologist: s0Bentonite From: <br />Grout SA---4.r�n: cP'/o <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />Public Water System Onsite: ❑ Yes [I No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes KNo <br />If yes, spoils storage Location: <br />Covered: ❑ Yes El No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: /!•/cam ce�*��-� <br />Gallons of Grout Used: 3S-0 <br />Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity I Tremie ❑Other: <br />Water <br />allons <br />SAN-AAQUIAll <br />�4 `' <br />-- COU N T Y- <br />'c:•.r-�Foa�"��' <br />Greatness grows here. <br />Environmeftl Health Department <br />Monitoring Well/Soil Boring Inspection Reporl <br />Date: Inspector: 9144 0;-A-"l-'0�vA CONSTRUCTION <br />Facility Address: d yA y y- 44 v—. X R-1, <br />Well Address: STotal Depth: <br />WP# Od ax Well#: I'�W—jf� Drilling Rig Type: <br />Soil Boring#: <br />Min 2" Annular EHD Seal Verified: <br />Drilling Company: ^-84 Screen Length From: <br />Driller Onsite: /V.O,- <br />Consultant: SPT / M Filter Pack From: <br />Geologist: s0Bentonite From: <br />Grout SA---4.r�n: cP'/o <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />Public Water System Onsite: ❑ Yes [I No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes KNo <br />If yes, spoils storage Location: <br />Covered: ❑ Yes El No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: /!•/cam ce�*��-� <br />Gallons of Grout Used: 3S-0 <br />Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity I Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Water <br />Rall ons <br />Cement 941b <br />Bags <br />Thickest Thin <br />a,&s <br />Thickest Thinnest <br />tlBags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 <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 1 70 <br />7 <br />20 40 <br />8 <br />40 1 80 <br />8 <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: 0.0 2— <br />Bags <br />Bags of Cement: 6 <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <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 />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 />