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SANA0A0U1N <br />Environmental Health Department <br />COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Date: -),)— <br />Inspector: <br />G tro-r� t <br />CONSTRUCTION <br />ttBags <br />Facility Address: <br />5 <br />� is <br />5 <br />10 <br />Well Address:0��L <br />5 <br />otal Depth: <br />10 <br />WP# '3 <br />2 <br />Well#: <br />Drilling Rig Type: <br />3 <br />Soil Boring#: (cj <br />fci2, 65 3, <br />(54 '657C <br />10 <br />20 <br />4 <br />20 <br />� <br />Min 2" Annular EHD Seal Verified: <br />El Yes El No <br />Drilling Company: <br />� ru Zv►1 <br />25 <br />50 <br />5 <br />Driller Onsite:. —Tv <br />w.wh <br />6 <br />Screen Length From: <br />To: <br />Consultant: �L1r4t <br />'�` <br />35 <br />Filter Pack From: <br />To: <br />Geologist: <br />U fit' -L <br />20 <br />Bentonite From: <br />To: <br />40 <br />80 <br />8 <br />Grout From: <br />To: <br />Public Water System Onsite: <br />Domestic Well Onsite <br />If yes, location and distance: <br />CAMPI IAIf <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 />If yes, material: <br />❑ Yes -�--Ro COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes -RIT <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes 121 I -o <br />GROUTING or DESTRUCTION Total Depth:lk Q jto <br />Depth to Water: <br />Grout Material: ►�� <br />Gallons of Grout Used: ^• SO 6aG D w S <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation/Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />,© Gravity �]FTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />ttBags <br />2.5 <br />5 <br />1 <br />5 <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 />35 <br />70 <br />7 <br />20 <br />40 <br />40 <br />80 <br />8 <br />Lmn <br />tt. <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.sucehd.com <br />