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SANdOA UIN <br /> ., COUNTY— Environmental Health Department <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: t{ �0 ins�tor: JCN1r`Q• CONSTRUCTION <br /> Facility A dress: '1 b <br /> Well Address: Total Depth: <br /> WP#i 001AS2piz WeIIH: 5\ Drilling Rig Type: <br /> Soil BoringN: qx �j� <br /> Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company_: jo f`Q, <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: r Aw 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 —i casing <br /> If yes, location and distance: � height <br /> R <br /> SAMPLING ABOVE-GROUND <br /> COWLETION compt.E-BOX <br /> Holding Temperature: coMP�rioN <br /> Method: Ground Sulac0 —;? — <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No tt• <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: �lonod <br /> 4acdoni _ 8 <br /> Covered: ❑ Yes ❑No — g-vw <br /> Pack <br /> If yes, material: <br /> t <br /> GROUTING or DESTRUCTION Total Depth: 34.5 20 x y = •. <br /> Depth to Water: tt• — tt• <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation KBoring Destruction 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 ATremie ❑Other: Type of Method: <br /> Water mer8471b Water Cement 94lb <br /> allons Bags eallons Bags <br /> Thickest Thinnest gs Thickest Thinnest #Bars 11121entonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 1.41 2.A7 <br /> s 10 2 10 20 2 Benlonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 - <br /> 10 20 4 20 40 4 <br /> 115 25 5 25 50 5 <br /> 15 3o 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 1 0 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.s'cehd.com <br />