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"cz SAN�IOUN <br />�c `��' Q� Environmental Health Department <br />�!.�1 —COUNTY— <br />'c9,,�'Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date:®�r4 zd� Inspector: &44,5" ^4 <br />Facility Address: /Z3 ✓4 I -vi -q /�Kw <br />Well Address: <br />WP# { Well#: <br />Soil Boring#: &/, Z, 3. <br />Drilling Company: SQle&", <br />Driller Onsite: , SCc&,._, <br />Consultant: -1SZLe&4-4. <br />Geologist: TRK <br />Public Water System Onsite: ❑ Yes allo <br />Domestic Well Onsite: ❑ Yes kNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑ No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 1S <br />Depth to Water: Nd G/'a�wA,f-Qr <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />L1 Boring Installation XDoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie Kother: f" Pt4/e <br />Water <br />gall s <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />ttBags <br />2.5 5 <br />1 <br />5 10 <br />5 10 <br />2 <br />10 20 <br />7.5 15 <br />3 <br />15 30 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />rnKKTRI IrTInIU <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />rnMPI FTInIV <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />MATERIALS/DEVELOPMENT <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 />9 N 1 hs 10aa– " w IF 5 8 w i l ()K 0-4 <br />20 40 6 40 SO 8 <br />5-2,.6-64110" US •b Brc/J+ uik - (o loo 5. 10/16/2017 <br />µz0 <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 />