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SAKAAQUIN <br /> .� Environmental Health Department <br /> COUNTY <br /> Greatness 5r( sws he,c, <br /> Monitoring Well/Soil Boring Inspection Report <br /> Dater Inspector: 5jhf MtMy0Wq CONSTRUCTION <br /> Facility Address: 44L-F L4W44le "�O, Lfth <br /> Well Address: Total Depth: <br /> WP# I-" Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes No <br /> Drilling Company: 9V1040viblinfat COY11101 lfwafn <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: p6kytroCSC1Zv�C� 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 casing <br /> If yes, location and distance: 37 <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLEr ON cLEnON <br /> Method: Ground Swf"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No Ili, ft. <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No = <br /> r <br /> If yes,spoils storage Location: atotwd <br /> on <br /> Covered: ❑ Yes ❑Nogravvi= i <br /> ack <br /> If yes, material: x = <br /> GROUTING or DESTRUCTION Total Depth: 2, ?: __ <br /> IF <br /> Depth to Water: ' I ft ft. <br /> Grout Material: waf MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: MW Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation t� Slot Size: <br /> oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED (( "" Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity )1 remie ❑Other: Type of Method: <br /> Water //Cement 471b Water Cement 941b <br /> allons Bags eallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 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 30 3 n (91 k <br /> 10 <br /> 10 20 4 20 40 4 � /O� /,I'\ `i n t !� <br /> 12.5 25 5 25 50 5 li v v ll <br /> 15 30 6 30 60 6 �� C1 1 I I 1 <br /> 1 35 7 35 70 7 // f r r `'\ ('1 <br /> 200 40 8 40 80 8 �� ��l s IJ L;( Vl/ ` (� <br /> J,6 W Oa b V� 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.secehd.com <br />