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SAN 0A0UIN <br />COUNTY <br />- Greatness grovis Mere. <br />LVrr7 <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspe tor: pj CONSTRUCTION <br />Facility Address:�2� 1�� �2ayi�� <br />'T--DT"-T- <br />Well Address: y Total Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring#: Min 2" Annular EHD Seal Ve%ified: <br />Drilling Company: <br />❑ Yes []No <br />Driller Onsite: AA - Screen Length From: To: <br />Consultant: <1_11d ego Filter Pack From: To: <br />Geologist: Bentonite 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 />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes <br />❑ Yes <br />❑ Yes []No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth:_ <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: J20, <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />Grout From: To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />M <br />MATERIALS/DEVELOPM ENT <br />Casing Type: <br />Blank 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 />Screen Feet <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 />1868 E. Hazelton A enue I Stockton, California 95205 1 T 209 468-3420 <br />10/16/2017 <br />F 209 464-0138 1 www.smcehd.com <br />