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SAN 1 U AU U I N Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: e6~ CONSTRUCTION <br /> Facility Address: 3 ' <br /> Well Address: Total Depth: <br /> WP# dd &9W Well#: Drilling Rig Type: <br /> Soil Boring#: B-© <br /> Drilling Company: G/f�'c ' ��r �j;•yl��' Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Screen Length From: To: <br /> Driller Onsite: rel" > � Filter Pack From: To: <br /> Consultant: AVS 420,.EKG <br /> Geologist: Bentonite Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: CONVLETION C�tFnoN <br /> Method: Ground Sumacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> ft. <br /> SPOILS <br /> = o <br /> Contamination Noted: ❑ Yes ❑No ` <br /> If yes, spoils storage Location: atanQe = B <br /> ascion <br /> Covered: ❑ Yes ❑No = � <br /> If yes, material: ` _= <br /> GROUTING or DESTRUCTION Total Depth: 4D <br /> Depth to Water: til n- <br /> Grout Material: /U0w /- APs * <br /> ,'C <<j�t <br /> ��„u. MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity f—✓ITremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> gallons Bas aallons Bags <br /> Thickest Thinnest NBags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 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.slcehd.com <br />