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SAN OUR, Environmc.. Health Department <br /> ° i.;l.. —cOUNTY— <br /> e1r""c.� Greotness grows here. <br /> pFx i <br /> Monitoring Well/Soil Boring Inspection Report <br /> CONSTRUCTION <br /> Date: ,o `\' 1M inspector: <br /> Facility Address: Total Depth: <br /> Well Ad ' well#:�aJ_ Drilling Rig Type: <br /> WP#- :'a,..��`v�� ,d <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: T ❑Yes <br /> ° <br /> Screen Length From: <br /> Drilling Company. From: To:� <br /> Driller Onsite: Filter Pack To:� <br /> Bentonite From: <br /> Consultant: From: To:� <br /> Geologist: Grout <br /> COMP LEA <br /> ❑Yes <br /> Stove Pipe ❑Christie Box <br /> INo <br /> Public Water System Onsite: ��pp ° height casing <br /> Domestic Well Onsi El Yes ) N <br /> If yes,location and <br /> distance: <br /> AgpVE.UaOUND Crwtstteox. <br /> SAME OOMpLETION COMPLETION <br /> Temperature: �"`G'W�s� <br /> aCe <br /> Holding Temp grout <br /> Method: ��_ft. <br /> Screening Method: tt. <br /> Verified Chain of Custody: ❑Yes ❑No _ <br /> SPOILS fe .- <br /> ❑Yes ❑No a <br /> Contamination Noted: 4ortad $ <br /> If yes,spoils storage Location:— ngravel Pack <br /> i c_ <br /> ❑Yes ❑No = ' <br /> Covered: <br /> If yes,material: it <br /> GROUTING or DESTRUCTION Zotal Depth: <br /> Depth to Water: MATER ELOPMENT <br /> Grout Material: Casing Type: Feet <br /> Blank Feet <br /> Gallons of Grout Used: Screen <br /> Well Destructi Slot Size: <br /> []Well Installation „'- , <br /> Bags of Cement: <br /> ❑Boring Installation ❑Boring Destruction Bags Sand/Gravel: <br /> METH Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑Pressure Grout []Over Drill Type of Method: <br /> ❑ Gravity �<Tremie ❑Other: <br /> Water Cement 471b <br /> Water cement 94lb <br /> ations 0a z <br /> a 3%MiX 5%MIX <br /> eons aa ' uag BentonitefCementMix 1.41 2A7 <br /> Thickest Thinnest es <br /> Bentonite per 47 Ib <br /> Thickest Thinnest k0ags 5 10 1 <br /> 25 10 20 : Bentonite er941b <br /> 5 10 3 a <br /> 15 30 <br /> 7.5 15 20 40 <br /> SO 10 4 25 50 5 <br /> 125 25 5 30 60 70 1 <br /> 17.5 35 7 35 40 so 3 10/16/2017 <br /> 20 40 3 <br /> 1868 E. Hazelton Avenue I Stockton,California 952051 T 209 468-3420 1 F 209 464-0138 1 www si_ ceh <br />