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SM Environmental Health Department <br /> COUNTY-_.._ <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 114 ' !Y Inspector: CONSTRUCTION <br /> Facility Address: LY,4,r,&d5r� <br /> Well Address: Total Depth: <br /> W P# V©S-ed Aey Well#: Drilling Rig Type: <br /> 'Soil Boring#: Bz- <br /> (�- �— <br /> Min 2" Annular EHD Seal Verified: El Yes []NoDrilling Company: <br /> Driller Onsite: A""51e- Screen Length From: To: <br /> Consultant: kli e t4e�'j e r , T" c Filter Pack From: To: <br /> Geologist: a K- Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COr"FLETION COMPLEMN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �tt' <br /> tt. <br /> tt. <br /> SPOILS <br /> . _ o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: slotted <br /> sawn <'• <br /> Covered: ❑ Yes ❑No = 9-911 <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: Z490t =_ <br /> Depth to Water: bf: i- o, e-(- Lu ^-Z 1?�.S tt tt' <br /> Grout Material: L-4"-d <br /> Gallons of Grout Used: 3� bvc.V-eh MATERIALS/DEVELOPMENT <br /> 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 /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Gravity 2STremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest sBags Thickest Thinnest it Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s'cehd.com <br />