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SANdOA UIN <br /> ' Q Environmental Health Department <br /> ��` I-•! ' ` —COUNTY— <br /> "+� .�;o+"' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 5 12 Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# M145qZg Well#: Drilling Rig Type: <br /> Soil Boring#: 1 Q <br /> Drilling Company: ?r Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: h 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 ❑No —r casing <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> CONPI.ETiON COMPLE-eOX <br /> Holding Temperature: contalETioN <br /> Method: oroum sumo.f <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No —ft. <br /> n. <br /> SPOILS <br /> x� a <br /> Contamination Noted: ❑Yes ❑No <br /> If yes,spoils storage Location: brad <br /> Covered: ❑Yes ❑NoQ-m Pack <br /> o <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> �. <br /> Depth to Water: <br /> Grout Material: <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 200�g61 Casing Type: <br /> ❑Well Installation NWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity kTre ❑Other: Type of Method: <br /> Water ment 471b Water Cement 941b <br /> allons Bags allons Baas <br /> Thickest Thinnest #ea Thickest Thinnest #Bags Bentonite/Cement Mix 3 *2.84.7 <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb <br /> 5 10 1 10 10 1 Bentonite per 94lb <br /> 7.5 15 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 11.5 25 5 35 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.socehd.com <br />