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SAN 10AQUIN <br />". ; --COUNTY - <br />"ORt,'' Greutness grows {sere <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 411121 Inspector: <br />Facility Address: (64hU 2 O(1- Dl,,&e I Rd . <br />Well Address: <br />WP# p D 413Li b Well#: <br />Soil Boring#: <br />Drilling Company: I(on <br />Driller Onsite: �V1L <br />Consultant: \\ <br />Geologist: <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 />❑ Yes El No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />rnNCTRI IrTIl1N <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />rnhAD1 FTI(11U <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />If yes, material: 1, <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: n <br />Grout Material: Nilk CA)n � k MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: [„5 nl <br />Casing Type: <br />[]Well Installation QWell Destruction Blank Feet <br />❑Boring Installation ❑Boring Destruction 1 <br />MFTWnn 1 im:n <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity NTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bags <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />48ags <br />2.5 <br />5 <br />1 1 <br />10 <br />1 <br />5 <br />10 <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 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 1 <br />40 <br />80 <br />8 <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 />ft. <br />Screen Feet <br />Bentonite/Gement 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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />