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—COUNTY— Environmental Health Department <br /> ", F�;,, •-' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: l/ Z Inspector: Silh(1 CONSTRUCTION <br /> Facility Address: , <br /> Well Address: Total Depth: <br /> WP# OD4(5U Well#: MW/ 3 jQ Drilling Rig Type: <br /> Soil Boring#: L���jWj ad MirMI;ndn 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> r <br /> Drilling Company: A�Yi <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Od lvltiLP G1fll1.:�✓1 L <br /> Filter Pack From: To: <br /> Geologist: Xt _ 7 _ Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> COMPLETION COMPLY-eO <br /> Holding Temperature: coMrlETioN <br /> Method: Ground Surfaos <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No �tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: <br /> rrbitad 8 <br /> tac7on �j <br /> Covered: ❑ Yes []No w _ gm Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 6� <br /> Depth to Water: 2,V tt. — ft. <br /> Grout Material: <br /> Gallons of Grout Used: a( MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation KWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> El Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity Tremie ❑Other: Type of Method: <br /> Water (cement 471b Water ment941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest Bentonite/Cement Mix 3% Mix %Mix <br /> 2.5 s 1 5 t0 1 Bentonite per 47 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 B 40 00 B <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 />