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SARAMIN <br />;—COUNTY— <br />Greatness <br />Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 3 ( tG (t -L Inspector: V t`C�� � CONSTRUCTION <br />Facility Address: W <br />Well Address: }_ __ _ _ Total Depth: <br />WP# � 5 l(b Well#: Drilling Rig Type: <br />Soil Boring#: [ <br />'[ Min 2" Annular EHD Seal Verified: <br />Drilling Company: W,4( t'[ * <br />❑ Yes []No <br />Driller Onsite: &%A�i AL -i >- L Screen Length From: To: <br />Consultant: t �!f tiWH Filter Pack From: To: <br />Geologist: a '� Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes eELNo COMPLETION ❑ Stove Pipe ❑Christie Box <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 />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes l Wo <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes EJ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 517 <br />Depth to Water: t ^ <br />Grout Material: W.tAk LLAvuv�' <br />Gallons of Grout Used: D -'*14�z <br />❑Well Installation ❑Well Destruction <br />❑Boring Installatiory lBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity 2Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />Izallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />RBags <br />Thickest Thinnest <br />J? Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />u <br />casing <br />height <br />—EWT <br />ABOVE -GROUND CHRISTY-BOX <br />COWLETION comPLEnoN <br />Ground Sumacs <br />grout <br />tt. <br />tt. <br />stonad <br />sacdon <br />gravel Pack <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 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 />