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SAN .L <br /> 61 ;` ;:�< IOAQUIN Environmental Health Department <br /> ' 6 _COUNTY— <br /> °'/ Greatness grows here, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date : X� 2. l Inspector: ( M, _,r. i CONSTRUCTION <br /> Facility Address: F N b'i 5 l4 <br /> Well Address : `2 ,"z t,t '\ ' c - Total Depth : <br /> WP# \'A2 , a S !S Well#: � - L1 31 Drilling Rig Type : <br /> Soil Boring#: - h > y ! Min 2" Annular EHD Seal Verified : ❑ Yes ❑ No <br /> Drilling Company: ? <br /> Driller Onsite: �G 1?_ s t _ Screen Length From : To: <br /> Consultant: <br /> Filter Pack From : To: <br /> Geologist: Bentonite From : To: <br /> Grout From : To: <br /> Public Water System Onsite : Yes ❑ No COMPLETION ❑ Stove Pipe [] Christie Box <br /> Domestic Well Onsite: ❑ Yes O�N0 casing <br /> If yes, location and distance : height <br /> SAMPLING ABOVE-GROUND crwts7i•-Box <br /> Holding Temperature : CowLL-rON COMP ETioN <br /> Method : G wnd sutx. <br /> Screening Method : grout <br /> Verified Chain of Custody: ❑ Yes ❑ Noll' <br /> SPOILS ff <br /> Contamination Noted : ❑ Yes No >-F <br /> If yes, spoils storage Location : smtwe '' ' = a <br /> sacdon a S <br /> Covered : Yes ❑ No = . gravol pack <br /> Ifyes, material : � SNif4 = ".. <br /> U t <br /> GROUTING or DESTRUCTION Total Depth : <br /> Depth to Water: 2 tt, — ft• <br /> Grout Material : MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used : Casing Type : <br /> ❑ Well Installation PWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑ Boring Installation ❑ Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel : <br /> Type/Brand of Bentonite : <br /> ❑ Pressure Grout Dover Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity PTremle Other: t LCcy Type of Method : <br /> Water Cement 471b Water Cement 94lb <br /> allons Bags gallons Bags <br /> Thickest Thinnest Neags Thickest Thinnest Aeags Bet7tOnite/Cement MIX 3% MIX 5% MIX <br /> 2 s 1 5 10 1 Bentonite per471b 1 .41 2.47 <br /> s to z 10 20 2 Bentonite per 94 Ib 2 .82 4 .7 <br /> 7.5 1s 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 70 7 <br /> 20 1 40 1 80 1 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 />