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° c SANdOA UIN <br /> E+1f •� � Q � Environmental Health Department <br /> '=`�.� —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: AS60— CONSTRUCTION <br /> Facility Address: 1003' <br /> Well Address: Total Depth: <br /> WP# oi�'3 Well#: Drilling Rig Type: <br /> Soil Boring#: 61, a-, 3 <br /> Drilling Company: r7r�tt ccyG Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: / <br /> Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO easing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROCINp <br /> CowLET10N COMPLY-BoX <br /> Holding Temperature: cornalEnoN <br /> Method: Grand s"i"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Noe• <br /> n. <br /> SPOILS — e <br /> Contamination Noted: ❑Yes ❑No i y7, <br /> If yes,spoils storage Location: <br /> nI ani = $ <br /> Covered: ❑ Yes El No — g-voPack <br /> If yes, material: c <br /> GROUTING or DESTRUCTION Total Depth: r =_ <br /> Depth to Water: Yy� tt• — n <br /> Grout Material:AA*l eemr— <br /> Gallons of Grout Used: 43.1, /-1t �I. iq �_ MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation 0•Boring Destruction 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 gTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags _ <br /> Thickest Thinnest itBags Thickest Thinnest 9Bags _BentonitelCement Mix 3% MIX 5%MIX <br /> 2.5 5 1 5 10 1 jBigntonite per47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 2.821 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 />