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SAN�'J 0A0U IN Environmental Health Department <br />—COUNTY <br />-11 <br />COUNTYP1rl�y,cl\`Greotness groves here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: l �v Inspector: v �'1 d CONSTRUCTION <br />Facility Address:„ �1 I1 �Y 'L , -S -C-6 CK <br />Well Address: Total Depth: <br />WP# d Well#: Drilling Rig Type: <br />Soil Boring#: % (” - 2 —0 36 Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Drilling Company: (110°04 - <br />Driller <br />• °Driller Onsite:IV Screen Length From: To: <br />Consultant: 11 Filter Pack From: To: <br />Geologist: i 'e✓G Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes El No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑ No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />i <br />GROUTING or DESTRUCTION Total Depth: J <br />Depth to Water: <br />Grout Material: C �� <br />Gallons of Grout Used: <br />[]Well Installation ❑Well Destruction <br />❑Boring Installation�oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �Tremie ❑Other: <br />Water <br />allons <br />3%, Mix 5% Mix <br />1.41 2.47 <br />Cement 471b <br />Bas <br />Water <br />allons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />2.5 5 <br />#Bags <br />1 <br />Thickest Thinnest <br />5 10 <br />#Bags <br />1 <br />5 <br />10 <br />_ <br />2 <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 1 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 1 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 1 <br />80 <br />8 <br />Illn—EN—INg>7 <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <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 />Screen Feet <br />Bentonite/Cement Mix <br />Bentonite per 47 Ib <br />3%, Mix 5% Mix <br />1.41 2.47 <br />Bentonite per 94 Ib <br />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 />