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$QNJOQQUIN Environmental Health Department <br /> • ( '� —COUNTY- <br /> -- Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:1�P���� inspector: CONSTRUCTION <br /> Facility Address: \ e O\ C•C • �4 �G— <br /> Well Address: U6 Total Depth: <br /> WP# \NQ T Well#: r&o Drilling Rig Type; <br /> Soil Boring#: t , Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 1 f� wle L n Screeength From: To: <br /> Driller Onsite: �OQ��A' ScrFilteen Le From: To: <br /> Consultant: <br /> Geologist; �dOP& ee Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No casing <br /> If yes, location and distance: � height . <br /> SAMPLING asove i;aouNo <br /> CowLEr1CIN CNR15rl•-BOX <br /> Holding Temperature: cobw FON <br /> Method: o`as"r8 r'4' . .* <br /> Screening Method: or4ut <br /> Verified Chain of Custody: ❑ Yes ❑No tt• <br /> tt. <br /> SPOILS tt• __ <br /> Y a ' <br /> Contamination Noted: ❑Yes ❑No _ <br /> If yes,spoils storage Location: �� t <br /> 8 <br /> Covered: ❑Yes El No s*ciicn <br /> If yes, material: _ <br /> _ <br /> or CTION Total Depth: %,Z$" <br /> Depth o ater: <br /> Grout Material: OYC v <br /> Epp a.! MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> 3 Casing Type: <br /> ❑Well Installation ,F❑,Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation y�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 OTremie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 941b <br /> allans Bags vallons Ba s _ <br /> Thickest Thinnest Hasp Thickest Thinnest q Bags _Bentonite/Cement Mix 3%MIX 5%Mix_ <br /> 2.5 5 1 s 10 1 IlElentorilte per 47lb 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94lb 2.821 4.7 <br /> 7.5 is 3 15 3o 3 <br /> to 20 4 20 40 4 <br /> 115 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 7 35 70 7 <br /> 20 40 0 40 Bo 0 <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 />