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Environmental Health De artment <br /> SANe p <br /> �.i_."J —COUNTY— <br /> �'�9r Greorr, ho re. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 10 1 L.J111 Inspector: L or b. CONSTRUCTION <br /> Premise Address: -10 f.Y1 <br /> WP#: 69 vo3r737 3 Total Depth: <br /> Well#: MtJM5A ,fnyjLiKz/.� Drilling Rig Type: <br /> Soil Boring Min 2"Annular Seal Verified: ❑ Yes El No <br /> Drilling Company: Cn:v 41r, nr, 116-�, ' I r Screen Length From: To: <br /> Driller Onsite: Filter Pack From: To: <br /> Consultant: A`n--%,a, T r7_^Ailro,nr..2N� -s• � . <br /> Geologist: �1 Bentonite From: To: <br /> g �� k <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ONO COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑NO casing <br /> If yes, location and distance: IIffT height <br /> SAMPLING ABOVE-GROUND <br /> C06VLEiON c <br /> wtmsox <br /> Holding Temperature: communoNoh+PlFnoN <br /> Method: GMndS t"' + <br /> Screening Method: about <br /> Verified Chain of Custody: ❑Yes ❑No —tt <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: —_ <br /> .tonal <br /> axaon <br /> Covered: El Yes ONO _ tx4vol Pack <br /> If yes, material: c <br /> GROUTING or DESTRUCTION Total Depth: / l <br /> Depth to Water: <br /> Grout Material: v'tak ('t6n4 & <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation [9*ell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout CtlOver Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity Rfremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement941b <br /> allons Bags allons Bags <br /> Thickest Thinnest #Bags Thickest I Thinnest #Bags <br /> 2.5 s 1 s 10 1 Bentonite/Cem 3/. Mix ent Mix 5% Mix <br /> s 10 2 10 20 2 Bentonite per 47 lb 1.41 2.47 <br /> 7.5 is 3 is 30 a <br /> 40 4 Bentonite per 94lb 2.82 4.7 <br /> 10 20 4 2 <br /> 12.5 25 s 2s so s <br /> is 3o 6 30 60 6 <br /> 17.5 35 7 35 <br /> 20 40 B 40 0 8 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />