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1) COUNTY N <br /> COUNTY Environmental Health Department <br /> • C <br /> uss grows here. <br /> Monitoring Well/Soil Boring Inspection Report J <br /> Date: 6t� Inspector: CONSTRUCTION 14 131t 14I / St �66 Al t id <br /> Facility Address: i l <br /> Well Address: dui) 5k.rw llz� t, .!v P Total Depth: <br /> WP# A4t�,�; Well#: fw-_ Drilling Rig Type: yrwr 12b4�wJ <br /> Soil Boring#: <br /> Drilling Company: (Y� Min 2"Annular EHD Seal Verified: 12iYes El No <br /> Driller Onsite: Screen Length From:_ To:_> <br /> Consultant: :u;�,5 Filter Pack From:-5-5 To:�"�_ <br /> Geologist: L.owt-xA Bentonite From:_($_ TO: <br /> Grout From: 1 )r To: 0 <br /> Public Water System Onsite: ❑Yes .R ll�o COMPLETION ❑ Stove Pipe Fgthristie Box <br /> Domestic Well Onsite: ❑Yes yJNo casing <br /> If yes, location and distance: � height <br /> SAMPLING ABOVE-GROUND <br /> CONFLETION C'k mpt.EnoN <br /> Holding Temperature: cohtaiETioN <br /> Method: Ground Satan 7_ <br /> Screening Method: arm <br /> Lk tt <br /> Verified Chain of Custody: ❑ Yes ONO 1 tt <br /> �tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = Y <br /> If yes,spoils storage Location: slotted ' _ s <br /> i _ 3 <br /> Covered: ❑ aocdonYes ONO = graval Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:_ <br /> Depth to Water: tt• — SS tt <br /> Grout Material: <br /> Gallons of Grout Used: 3 4® MATERIALS DEVELOPMENT <br /> Casing Type:: eked- <br /> Well Installation ❑Well Destruction Blank %0 Feet Screen jP-12_Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: 04S <br /> Bags of Cement: ri (qA L(�_P�: 5 5 me11t� <br /> METHOD USED Bags Sand/Gravel: - <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: &7 <br /> Filter Pack Type/Size: 1&3 <br /> ❑ Gravity PTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags eallons Bags <br /> Thickest Thinnest aBags Thickest Thinnest 4Bags _ BentonitefCement Mix 3% MIX 5%MIX <br /> 2.5 5 1 5 to 1 Bentonite per 47 lb 1 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 <br /> 12.5 25 5 25 50 <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 />