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SAN 10AQUIN <br /> Environmental Health Department <br /> C O U N T Y --- <br /> ` �t�Pi Greatness grows here . <br /> Monitoring Well /Soil Boring Inspection Report <br /> Date , ' Inspector : Si ru CONSTRUCTION <br /> Facility Address : 11 <br /> Well Address : Total Depth : <br /> WP #..U ,L 19 (X) Well # : fl- Us Drilling Rig Type . <br /> Soil Boring# : Min 2 " Annular EHD Seal Verified : ElYes ❑ No <br /> Drilling Company : �)` � � eco <br /> Driller Onsite : Screen Length From : To : <br /> Consultant : Filter Pack From : To : <br /> Geologist : L 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 : height <br /> SAMPLING ASOVE-GROUND tS rY-8oX <br /> Holding Temperature : <br /> COMPLETION <br /> Method , c�rocmd sir ' +"" <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes ❑ No mmsewas ftsw <br /> ft. <br /> ft. loss 10001401110 <br /> SPOILSow <br /> —' <br /> Contamination Noted : ❑ Yes ❑ No h = 4 <br /> a <br /> 9. . <br /> If yes , spoils storage Location : <br /> stoned yf' <br /> action <br /> Covered : ❑ Yes ❑ No <br /> . . pra,r,al pacts <br /> If yes , material . <br /> GROUTING or DESTRUCT ON Total Depth : <br /> Depth to Water : ft- ft• <br /> Grout Material : <br /> Gallons of Grout Used : z MATERIALS / DEVELOPMENT <br /> Casing Type : <br /> ❑ Well Installation PIUell Destruction Blank Feet Screen Feet <br /> ❑ Boring Installation ❑ Slot Size : <br /> Boring Destruction Bags Sizes <br /> Cement : <br /> METHOD USED Bags Sand /Gravel : <br /> Type/ Brand of Bentonite : <br /> ❑ Pressure Grout ❑ Over Drill <br /> Filter Pack Type/Size : <br /> ❑ Gravity I&Tremie ❑ Other : Type of Method : <br /> Water Cement 47lb Water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest # Bags Bentonite/Cement Mix 3 % MIX 5 % MIX <br /> 2 , 5 5 1 5 10 1 Bentonite per 47 Ib 1 .41 2 .47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2 . 82 4 . 7 <br /> 7. 5 15 3 15 30 3 <br /> 10 20 4 t/ 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 Stockton , California 95205 T 209 468- 3420 F 209 464- 0138 www . smcehd . com <br />