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SAN J UAQ U I N Environmental Health Department <br /> COUNTY <br /> F' <br /> Oat"' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7'-Z/''"�-Z Inspector: CONSTRUCTION <br /> Facility Address: I736D BeAonj oe, <br /> Well Address: Total Depth: <br /> WP# 60`/3 S/0/1 Well#: Drilling Rig Type: <br /> Soil Boring#: SS 3 <br /> Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: j�ig� 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 ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVE-GROUND CHRLSTY_ <br /> Holding Temperature: COWLET;ON COMPLEnoN <br /> Method: G=nd Surtwe <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> tt. <br /> it. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No = c <br /> If yes, spoils storage Location: abe <br /> a�c.on — B <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: M tt' <br /> Grout Material:�/V�<s �Pe,�� f <br /> Gallons of Grout Used: ip ,5j/`y— MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Coring 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 /> ElN Gravity remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gallons Bas allons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest 4Bags 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 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 1 20 4 20 40 4 j/ �Ad <br /> 12..5 25 5 25 50 5 / <br /> 15 30 6 30 60 6 (� <br /> 17.5 35 7 35 1 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 />