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SAN 10AQUIN Environmental Health Department <br /> —COUNTY <br /> Greotness <br /> COUNTYGreotness grows hei t <br /> Moni oring Well/Soil Boring Inspection Report <br /> Date. l �- Inspecto - `�% <br /> : CONSTRUCTION A � <br /> Facility Address. �Y tf /{1 —>L'iA <br /> Well Address- -Su Total Depth: "tV / VK uQL <br /> WP# -15WII#: Drilling Rig Type: <br /> Sell Bering#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: - Filter Pack From: To: <br /> Geologist: 41 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: �ffl height <br /> SAMPLING ��- C��(('IlkABOVE-GROUND CHMM4= <br /> Holding Temperature: COWPLETION cOwjnEnON <br /> Method: G=nd Sirtacs <br /> Screening Method: o�«a <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No r` <br /> If yes,spoils storage Location: slotted M =_ <br /> tee�an <br /> Covered: ❑ Yes ❑No =' <br /> g-vial pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: C) -_ <br /> Depth to Water: 1.5 n- n' <br /> Grout Material: P _t— -tcy�y'la(I MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installationring Destruction Slot Size: <br /> 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 UlTremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #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 /> 5 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 1 35 70 7 <br /> 20 (40 8 40 80 8 <br /> ti ^ —bl16/2 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 www.s'cehd.com <br />