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N <br /> SANe�lOAQUIN Environmental Health Department <br /> —COUNTY— <br /> ...'a,,-.as Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:'f z-tg.-zoz o Inspector: h"&G CONSTRUCTION <br /> Facility Address: youg W 042K Total Depth: <br /> Well Address: <br /> WP# tbyOW-1 Well#: Drilling Rig Type: <br /> Soil Boring#: t3,1 60 134 Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: Adr ��C-+� E •'^"^ ^�"t Screen Length From: To: <br /> Driller Onsite: kt, ✓, Filter Pack From: To <br /> Consultant: 54ovu Bentonite From: To: <br /> Geologist: & J t° Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ONO casing <br /> height <br /> If yes,location and distance: <br /> SAMPLING ABOVEGROUND Ck4Raw•eox <br /> COWLE'rION COMPLETION <br /> Holding Temperature: G ovnd su tax•7� <br /> Method: r grout <br /> Screening Method: t�, # <br /> Verified Chain of Custody: ❑Yes ❑No tt• <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: L�1/Z 116, `��n _ .8 <br /> Covered: ❑Yes ❑No / _ a•�t+� <br /> If yes, material: 133 t <br /> GROUTING or DESTRUCTION Total Depth: 17 -:or tt <br /> Depth to Water: Ava&w <br /> Grout Material: /NO+ /` MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used:-/r 5e//a/r 5e//a. Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> /,�r 0'iW� Slot Size: <br /> ❑Boring Installation Goring Destruction /etc 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 [a'Other: <br /> Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Ba s allons Ba - <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags lBentontt91Cement M1x 3°/a MIx 5%Mix <br /> Bentonite per 4110 1.41 2.47 <br /> 2.5 s 1 s 10 1 2.82 4.7 <br /> 5 10 2 to Bentonite per 941b <br /> 10 15 <br /> 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 so 5 <br /> is 30 6 3o 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 411 B 4o Bo e 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.co <br />