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SANJ0A Q UIN <br /> ' `= Environmelr.al Health Department <br /> —COUNTY— <br /> Greatness grows her,,. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I-i7-/9 Inspector: NA,tE-ems CONSTRUCTION <br /> Facility Address: /5«3• 4A-re4 r <br /> Well Address: Total Depth: G <br /> WP#4o379SG Well#:S�p / .Z Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 4dw* Screen Length From: To: <br /> Driller Onsite: S/aw <br /> Consultant: Filter Pack From: 03— To: b <br /> Geologist: 'WAK Bentonite From: To: 3 r <br /> Grout From: 3 To: a <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 T. <br /> SAMPLING ABOVEGROUND CMISTYT <br /> COMPLETION COMPLE-BO <br /> Holding Temperature: coM,PlETioN <br /> Method: Gmurdsvlae.�— <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes o ( ft. <br /> �1lWr ty�'2 vv� N. <br /> tt. _ <br /> SPOILS <br /> Contamination Noted: ❑ Ye ❑No t <br /> b� S <br /> If yes,spoils storage Location: nod <br /> mdon 12 _ 8 <br /> Covered: ❑ Yes No 11,_ a-�� <br /> If yes, material:GROUTING or DESTRUCTION Total Depth:Depth to Water: n• 1.1 �TM <br /> Grout Material: - <e w-.� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> FWell Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <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 ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags 9allons Bairs _ <br /> Thickest Thinnest It Bags Thickest Thinnest nBags _Bentonite/Cement Mix 3% Mix 5% MIx <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2LA7 <br /> 5 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 <br /> 7.5 15 3 15 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 35 70 7 <br /> 20 40 8 40 80 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.s'cehd.com <br />