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i SANGJ0A0UIN <br /> Environmental Health Department <br /> I, '11-Ii: " —COUNTY— <br /> :ryT <br /> ,�C�•GFOV`ri• G(eo YneSS grows here. <br /> � 1 Monitoring Well/Soil Boring Inspection Report <br /> Date:w��^^\ W"Jhspector: CONSTRUCTION <br /> Facility Address: bIINWIV <br /> Well Address: 0A, Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: y9'- I Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: �� 454! r� <br /> Driller Onsite: 4nbky-" EU..ssO Screen Length From: To: <br /> Consultant: s FQ.�C`i 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 �1 No casing <br /> If yes, location and distance: height ; ' <br /> 7WSAMPLING ABOVEGROUND <br /> Holding Temperature: <br /> COMPLETION COMPLETION <br /> Method: CLotindsulx.: �- <br /> Screening Method: prjom <br /> Verified Chain of Custody: ❑ Yes El No i— H• <br /> SPOILS Ell <br /> Contamination Noted: ❑Yes ❑NoIf yes,spoils storage Location: stonedCovered: ❑Yes ❑No an <br /> If yes, material:GROUTING or DESTRUCTION Total Depth:Depth to Water: tG to <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <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 /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity [�]Tremie ❑Other: Type of Method: <br /> Water l Cement 471b Water Cement 941b <br /> Ilons Bags eall s Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 5%Mlx_ <br /> 2 s 10 1 Bentonite per 47lb 1.41 2.47 <br /> s 1 2 10 20 2 Bentonite per 94lb 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 1s 30 6 30 60 6 <br /> 17.5 35 7 95 70 7 <br /> 20 40 3 40 30 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.socehd.com <br />