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-� SA NUJ OAQ U I N Environmental Health Department <br />COUNTY --- <br />Greatness grows here j <br />Monitoring Well/Soil Boring Inspection Report <br />Date: � / � o- <br />Inspector: bu� CONSTRUCTION i <br />Facility Address.me�C,<-w� �� � 57 bS 6y +> f� <br />Well Address: _ 4�rgvn -t-, Total Depth: 20 II <br />WP# 0 O 3 Z 5 Well#: Hwy `i- Drilling Rig Type: <br />Soil Boring#: <br />Min 2" Annular EHD Seal Verified: ElYes ❑No <br />Drilling Company: F c- Y' <br />Screen Length From: To: <br />Driller Onsite: <br />Consultant: e to Filter Pack From: To: <br />Geologist: Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />❑ Yes E] No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑ No <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />WTcasing <br />height <br />ABOVE -GROUND CHRLSTY43OX <br />COWLETION COMPLETION <br />ciround sulacs �— <br />© IL f(— <br />grout <br />t(D ie n. <br />_ a <br />sbttad > _ -E <br />scion <br />g-vwi pack <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: . <br />Depth to Water: br,�� tt. tt• <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation �❑%%Well Destruction <br />❑Boring Installation Boring Destruction <br />METHOD USED // 1 <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity `VTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />tlBags <br />Thickest Thinnest <br />Jt Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />1 40 <br />80 <br />8 <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />21:1 �`1' ► b (. bi:=�r.1� 10/16/2017 <br />�_ �152iTit4���SS'�9111868 E. Hazelton Avenue I Stockton, Californa T 209,T68-34201 F 20J464-0138 1 www.s*cehd.com <br />oY i 1 Cq+-q� 1.`:5 5 <br />