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R'°UlN C <br /> SAK JOHNIN Environmental Health Department <br /> • �" �,1 <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: (rlv"L CONSTRUCTION <br /> Facility Address: '=V"V Lpy4, <br /> Well Address: Total Depth: <br /> WP# A–)--2 k0 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: (T(�c Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: iMi°� �- C. Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: S aLuk-- Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes EJ No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: Ground Surl'o' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> it. <br /> ft. <br /> SPOILS <br /> = o <br /> Contamination Noted: ❑ Yes El No = <br /> If yes, spoils storage Location: abttad <br /> aacdon <br /> Covered: ❑ Yes ❑No = 0-1 <br /> PaCK <br /> If yes, material: =_ <br /> GROUTING or DESTRUCTION Total Depth: 67 <br /> Depth to Water: �1 <br /> Grout Material: X MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ^ it w-f <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring InstallationT*oring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout []Over Drill Filter Pack Type/Size: <br /> ❑ Gravity premie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags Rallons Bags <br /> Thickest Thinnest »Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 3% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 204 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 35 35 70 7 <br /> 40 8 40 80 8 <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 />