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Environmeti,al Health Department <br /> —coUNTY— <br /> �. %/ Greatness gross herr- <br /> anr <br /> Monitoring Well/Soil Boring Inspection Report <br /> 10 1 EtIO Inspector: 1\ uy CONST <br /> RUcTION <br /> Date: 1 � w <br /> Facility Address: a Total Depth: <br /> Well Address: Drilling Rig Type: <br /> Well#: _ <br /> WP# Min 2"Annular EHD Seal Verified: ❑Yes El No <br /> Soil Boring#: From: To:� <br /> Screen Length <br /> Drilling Company: �qt From: To:� <br /> Filter Pack To:� <br /> Consultant: <br /> : , It h^nXi'11V b! � h��'/� Bentonite From: <br /> Consultant: From: To:� <br /> Geologist: Grout <br /> ❑ <br /> [I Yes ❑No COMPS N Stove Pipe Christie Box <br /> Public Water System Onsite: casing <br /> ❑YE:S ❑NO height <br /> Domestic Well Onsite: <br /> If yes,location and distance: <br /> "'-eox. <br /> CowLEnOND COMPt.E PN <br /> SAMPLING pco ind Surlaca —�"�� <br /> Holding Temperature: oro� <br /> Method: <br /> Screening Method: n. <br /> ❑Yes ❑No --n <br /> Verified Chain of Custody: <br /> El Yes ❑No ; _ s <br /> Contamination Noted: stcttaa ; = E` <br /> If yes,spoils storage Location: aacdon si = gmvw Pack <br /> ❑Yes El No <br /> Covered: <br /> If yes,material: p tt. <br /> GROUTING or DESTRUCTION Total Dep the0� � tt. <br /> Depth to Water: D Ib bAA rvirs cosetc/DEVELOPMENT <br /> Grout Material: Casing Type: Feet <br /> Gallons of Grout Used: Blank Feet Screen <br /> Well Destruction PCS Wt'U <br /> pWell Installation Slot Size: <br /> Bags of Cement: <br /> El Boring Installation []Boring Destruction Bags Sand/Gravel: <br /> METH Ey p1o�\V Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑Pressure Grout Dover Drill Type of Method: <br /> Gravity OTremie ❑Other: <br /> cement 941b <br /> water cement 471b Water ea z <br /> ailons Thic 3°fa Mix 5%Mix <br /> Ba : all°ns BentonitelCement Mix <br /> er471b 1.41 2.47 <br /> kest misses! #Bags <br /> genlonite p <br /> Thirkest 7hlnnest #Bags 5 SO 1 <br /> 1 2 i3entonHe per 941b <br /> zs 5 10 20 <br /> 5 10 2 15 30 3 <br /> 7.5 <br /> 15 20 40 4 <br /> 10 20 5 25 50 5 <br /> 25 60 6 <br /> 115 30 7 35 70 s 10/16/2017 <br /> 17.5 35 40 30 <br /> 20 40 0 <br /> 1868 E. Hazelton Avenue 1 Stockton,California 952051 <br /> T 209 468-34201 F 209 464-0138 1 www si_ceh <br />