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SANAW N <br /> Environmental Health Department <br /> '; _ <br /> COUNTY— <br /> F_:r <br /> �9,It�•;+�� GlPO tOPSS (31'OI'/S here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: lam CONSTRUCTION <br /> Facility Address:^uwr_'44 �ayylk5✓ lte� <br /> Well Address: Total Depth: <br /> WP#e?!>!%1� Well#: �y 7 91,JU Drilling Rig Type: <br /> Soil Boring#: /2 If Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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: IIffT height <br /> W_ —WW7:F <br /> SAMPLING ABOVE-GROUND <br /> COWLETION COMPLETION <br /> Holding Temperature: cornrlerioN <br /> Method: GroundSulaes <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Nott <br /> tt. <br /> SPOILS — <br /> e <br /> Contamination Noted: ❑ Yes ONO <br /> If yes,spoils storage Location: <br /> tbtsad yr _ <br /> wcdon <br /> Covered: ❑ Yes LINO — Pack <br /> If yes, material: f c <br /> GROUTING or DESTRUCTION Total Deptho '/ sr�syi 0Zi`y/ 51 <br /> Depth to Water: tt• — tt <br /> Grout Material: 9 <br /> Gallons of Grout Used: //psi( ! MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation l<Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity ATremie AVJDther: �S�V,0 Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5%MIX <br /> 2.5 5 1 5 10 1 Bentonite per47lb 1 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 2.821 4.7 <br /> 7.5 15 3 is 30 3 <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 3s N 7 <br /> 20 40 8 1 40 BO 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 />