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UIN <br />Environmental Health Department <br />'- —COUNTY— <br />Cement 941b <br />BajZs <br />_ -- Cre4tneis qro A's here. <br />4 Bags <br />Monitoring Well/Soil Boring Inspection Report <br />Date: It7 t Inspector: C (o <br />CONSTRUCTION z <br />Facility Address: �r;G I E . ,/, <br />1 <br />Well Address: <br />Total Depth: <br />WP# OL7jjj�j IL7 Well#: <br />Drilling Rig Type: <br />Soil Boring#: <br />Min 2" Annular EHD Seal Verified: El Yes ❑No <br />Company: <br />Drilling p y: X14 ew✓n,o y% 1S , .Ti S�i�'e �,,. <br />20 <br />Driller Onsite: MC VA, <br />Screen Length From: To: <br />Consultant: <br />Filter Pack From: To: <br />Geologist: <br />Bentonite From: To: <br />3 <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes ❑No <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <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 ❑No <br />❑ Yes EJ No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth: Anft I*&— <br />Depth to Water: D <br />Grout Material: ►t��� <br />Gallons of Grout Used: <br />❑Well Installation [9'rVell Destruction <br />❑Boring Installation ❑Boring Destruction <br />HVIV41ioral 7■cyyft, <br />❑Pre sure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />Rall ons <br />Cement 941b <br />BajZs <br />Thickest Thinnest <br />4 Bags <br />Thickest Thinnest <br />tlBags <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 />40 <br />80 <br />8 <br />casing <br />height <br />3 <br />ABOVE -GROUND cr �s ri sox <br />CO&FLE7ICN ccwLEnoN <br />Gnwnd surface <br />or�:rt <br />ft_ <br />#t. <br />_nF <br />- � P <br />O <br />sioiwd = <br />gr-Vwice= <br />FEENE1011� <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 lb 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 IF 209 464-0138 1 www.slcehd.com <br />