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SMJDAQUIN Environmental Health Department <br /> —COUNTY— <br /> • <br /> Greo•tness grows here- <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: /� " I nspecto rPlol CONSTRUCTION <br /> Facility Address: /07 S', Nl ;X Wa <br /> Well Address: Total Depth: <br /> WP# lyo'-�V Well#; /LLG✓ Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: C r 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 El Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing ' <br /> If yes,location and distance: height <br /> "ii � • <br /> SAMPLING . <br /> cntaPi~rrioty r.�irsryr sox ' <br /> Holding Temperature: COMPLETION <br /> Method: "'5ir1 � <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑Non' <br /> tt. <br /> SPOILS <br /> Contamination Noted: El Yes ❑No r, _ <br /> If yes,spoils storage Location: = - � <br /> ❑Yes ❑No scn <br /> Covered: �•-� �,-„� <br /> If yes, material: <br /> GROUT]NG.or-DESTRUCTION.Total Depth:_ ••'7 ' <br /> Depth to Water: n' JIL _. tt. <br /> Grout Material; /IO MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation WWell 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 QiTremie Other: A-6—ity Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> gall gallons Ba s <br /> Thickest Thinnest naags Thickest Thinnest tiBags Bentonite}cement Mix 3% Mix 50/, Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 . <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 90 3 i i i <br /> 10 20 4 20 40 4 <br /> 25 5 25 50 5 <br /> is <br /> 15 30 6 30 60 6 Q� // <br /> 17.5 95 7 35 70 7 / �` <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138.1 www.slcehd.com <br />