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S_COUNTY-AN,IOAQUIN <br /> N k l Environmental Health Department <br /> • J --- <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: W l Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: ?ac-o C RAl.- r� Total Depth: <br /> wP# (2?R y Ss'S Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: =/ nN!2-', 7i±�— Screen Length From: To: <br /> Driller Onsite:.,` � creM Filter Pack From: To: <br /> Consultant: <br /> Geolo s�,,,� Bentonite From: To: <br /> 1st: <br /> g &'n � Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING AWIVE-GROUND <br /> Holding Temperature: COMPLETION cOMP�LEnoN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —ft. <br /> it. <br /> ft. <br /> SPOILS a; <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted <br /> soon W <br /> Covered: ❑ Yes ❑No y <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: n• n' <br /> Grout Material:--y MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installationell 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 [s;,I**remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Izallons Bags <br /> Thickest Thinnest pBags Thickest Thinnest pBags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 s 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 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 20 40 4 �� <br /> 12.5 25 5 25 50 5 J/ <br /> 15 30 6 30 60 6 G <br /> 17.5 35 7 35 70 7 J <br /> 20 40 8 40 80 8 <br /> (?vi��__A "W 4, crJ" ".44- to,1 S Sim•�( rte {.fit 10/16/2017 <br /> 186�8�EHazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 A� www.s'cehd.com <br /> o- ♦/s�°q v�d' 6"'�r`(�, -�'' r1,vHA vel. 0.`1 wrjvr+� w.+'3-c� `1'�►- `''t� <br />