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SALMON Environmental Health Department <br /> COUNTY— <br /> \"9cironS" Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ���2�--2�� inspector: /Aeel CONSTRUCTION <br /> Facility Address: (039 cd. C a4 t?wxa <br /> Well Address: Total Depth: <br /> Wp# ,�; yyg(, Well#: Drilling Rig Type: <br /> Soil Boring#: 2. — Min 2"Annular EHD Seal Verified: ElYes El No <br /> Drilling Comp <br /> any ✓[U <tc GfA <br /> Driller Onsite: �er� Screen Length From: To: <br /> VA Filter Pack From: To: <br /> Consultant: 4,Z1u m,,s r n <br /> G � � Bentonite From: To: <br /> Geologist: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No —r casing <br /> If yes,location and distance: height <br /> WT <br /> SAMPLING AB0VE.6ROUND CHRMTY4M <br /> Holding Temperature: COMPLETION COMPLETION <br /> Ground suriacv —• —Method: '— T <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> SPOILS <br /> ft• � p <br /> Contamination Noted: ❑Yes El No <br /> If yes,spoils storage Location: Slott ad L'Y' � B <br /> aar.'on ,a{ <br /> Covered: ❑ Yes ❑No = gavel Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: NC7 c✓� !r tt' <br /> Grout Material:�it�i e MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: %fn Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Baring InstallationABoring 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 ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> p2t <br /> ns Bags Fall is Bags <br /> thinnest #Bags Thickest Thinnest #Bags Bentonite/Cennent MIX 3%Mix 5%Mix <br /> s 1 5 10 1 Bentonite er 47 Ib 1.41 2.4710 2 10 20 2 Bentonite er 94lb 2.82 4.715 3 15 3o 320 4 20 40 4 <br /> 25 5 25 50 5 <br /> 30 6 30 60 35 7 35 70 7 <br /> 40 B 40 BO B <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.slcehd.com <br />