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SAK <br /> 40w 4 <br /> 14�. Q Environmental Health Department <br /> COUNTY <br /> ; ter `^ ` I GreQtness grows here . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date , � Inspector : CONSTRUCTION <br /> Facility A dr ss : <br /> Well Address : 'Z. "Z% COf7) 1 S CS, STP, Notal Depth . <br /> WP# �{ 2 (9 22 Well # : h�`., r Drilling Rig Type . <br /> Soil Boring# : Min 2 " Annular EHD Seal Verified : ❑ Yes ❑ No <br /> Drilling Company : Screen Length From : To : <br /> Driller Onsite : <br /> Consultant : (Ib % T> C> Q_, Filter Pack From : To : <br /> ` Bentonite From : To : <br /> Geologist : <br /> Grout From : To : <br /> Public Water System Onsite : ❑ Yes No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : Yes ❑ Noasang <br /> If yes, location and distance : � , <br /> height <br /> SAMPLING -dR0mt0 <br /> Co1F �r>c N <br /> Holding Temperature : crWf:�T4ON <br /> Method : Grodnd S'Z110T <br /> Screening Method : �t <br /> 09 <br /> d Chain of Custody . El Yes [] No <br /> ' <br /> Verifie .h y <br /> ow�wflw cow wommommoo <br /> SPOILS <br /> Contamination Noted : ❑ Yes No <br /> If yes, spoils storage Location : & -� <br /> Z*Cjon <br /> Covered : ❑ Yes No <br /> Pack <br /> If yes, material : <br /> GROUTING or DESTRUCTION Total Depth : <br /> Depth to Water : <br /> Grout Material :Gallons of Grout Used : ZO � Z. S MATER (ALSjDEVELOPMENT <br /> Casing Type : <br /> ❑ Well Installation Well Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> ❑ Boring Installation ❑ Boring Destruction Bags of Cement : <br /> METHOD USED Bags Sand /Gravel . <br /> Type/ Brand of Bentonite : <br /> Pressure Grout ❑ Over Drill Filter Pack Type/Size : <br /> ❑ Gravity PTremie ❑ Other : Type of Method : <br /> Water cement 471b 'Nater Cement 941b <br /> allons Bas gallons. . Bags <br /> Thickest Thinnest Bags Thickest Thinnest # Bags BentoniteXelment Mix 3 % Mix % Mix <br /> 25 5 1 5 10 1 Bentonite per 47 lb 1 .41 2047 <br /> s z In zo 2 Bentonite per 94 Ib 2082 $ . 7 <br /> 7. 5 15 15 30 3 a <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 �11 40 80 8 <br /> 10/ 16/2017 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468 -3420 1 F 209464- 0138 www . sjcehd . com <br />