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$AN J 0 A 0 U Environmental Health Department <br /> —COUNTY— <br /> •,�9yF,,,,a'.� Greatness grows here. <br /> O Monitoring Well/Soil Boring Inspection Report <br /> Date: o/$ / Inspector: en& CONSTRUCTION \ <br /> Facility Address: 1/� <br /> Well Address: Total Depth: Q ' <br /> WP# I W II#: QDrillingRigType: \ <br /> Soil Boring#: o V i 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: O IL Q Fog <br /> � <br /> Driller Onsite: 0� Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: El Yes o ageing <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-GROUND Gmtsw-giox <br /> Holding Temperature: cota'LETION �pLET1ON <br /> Method: —�Otossndsur.o. <br /> Screening Method: glout <br /> Verified Chain of Custody: ❑Yes ONO <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No — <br /> If yes,spoils storage Location: sicttad <br /> sec7on <br /> Covered: ❑Yes ONO <br /> If yes,material: nn <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: D Y r C T1 tt• — ' �tt. <br /> p no / <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: °r Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation4Boring 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 91'remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94lb <br /> all ons Bagsa <br /> Bags <br /> Thickest Thinnest pBags #Bags BentonitelCement Mix 3a/o MIX 5% mix] <br /> 2.s s 1 1 Bentonite er47lb 1.41 2.47 <br /> s 10 2 2 Bentonite per 94lb 2.82 4.7 <br /> ZS 15 3 3 <br /> 30 20 4 4 <br /> 12.5 25 5 5 <br /> 15 30 6 6 <br /> 17.5 35 7 7 <br /> 20 40 B 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue ( Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s"cehd.com <br />