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nVi <br /> SAN,J0A0UIN Environmental Health Department <br /> —COUNTY— <br /> `til,; Greatness grows here, <br /> • FCC <br /> Monitor' g Well/Soil Boring Inspection Report <br /> Date; �_1 Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# �`�`L S ' Well#: Drilling Rig Type; <br /> Soil Boring#: C A �1.`1 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller Onsite; <br /> Q`�� <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: `(��,kr Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes / No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: CowPLF-T;oN COMPLErioN <br /> Method: °roUndSurfwe "+ <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes ❑Noft' <br /> ft. <br /> SPOILS F% <br /> O <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: stottvd M , <br /> sac9on = A <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:\& <br /> Depth to Water: <br /> Grout Material: N 4A-S"\ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used; '�&, %!'N Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation f Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pacl<Type/Size: <br /> ❑ Gravity �Tremie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 941b <br /> gall Bags allons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 55% MIX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 1 z 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 1 3 15 30 9 <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 35 70 7 <br /> 2D 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />