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SQNIJOQQUIN I=.nvironmental Health Department <br /> —COUNTY— <br /> ' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 25 23 Inspec or: CONSTRUCTION <br /> Facility Address: t{ <br /> Well Address: Total Depth: <br /> WP# Of) QU s Well#-: O Drilling Rig Type: <br /> Soil Boring#• �3► N �S Jl )6`/1 Min 2"Annular EHD Seal Verified: ❑Yes ONO <br /> Drilling Company: <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: 41LCQ Filter Pack From: To: <br /> Bentonite From: To: <br /> Geologist: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No —r casing <br /> If yes, location and distance: I_—Er height <br /> SAMPLING ABOVE-GROUND CHRi.,gpx <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: Ckound s ulxs <br /> Screening Method: gfOut <br /> Verified Chain of Custody: ❑ Yes ❑Non' <br /> N. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No ` _ J <br /> If yes,spoils storage Location: stoned <br /> w %Fon = 8 <br /> Covered: ❑ Yes ❑No — gr, ,I PackIf yes, material: V i2�sl <br /> GROUTING or DESTRUCTION Total Depth: to i to S L <br /> isEff]Depth to Water: n' ft <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring installation%Boring Destruction 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 (SITre ❑Other: Type of Method: <br /> Water ement 471b Water cement 941b <br /> allons Ba s allons Bags <br /> Thickest Thinnest gs Thickest Thinnest 40a� eentonitexement Mix 3% MIX 5%Mix <br /> 2.5 a 1I s to 1 Bentonite er47lb 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 lb 1 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 115 <br /> 20 4 20 40 4 <br /> 25 5 25 50 5 <br /> 30 8 30 BO 8 <br /> 35 7 35 70 7 <br /> 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 />