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SAN ]: OAQUIN <br /> I(( SAN NTY— Environmental Health Department <br /> y <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: InspectCONSTRUCTION <br /> Facility Address:2'y't1iV r r2 <br /> Well Address: Total Depth: <br /> WP# ev Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: /Ylg��/fi.� Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: 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 El No casing <br /> If yes, location and distance: height <br /> .W7;F <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONP�iON c�tFnoN <br /> Method: Ground S"""' <br /> Screening Method: cr«n <br /> Verified Chain of Custody: ❑ Yes ❑No —n' <br /> tt. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes, spoils storage Location: slotted <br /> sac.on <br /> Covered: ❑ Yes []No <br /> g-vw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: L7j <br /> WE <br /> Depth to Water: -C <br /> Grout Material: r3r'tj� �/! _J, �C <br /> Gallons of Grout Used: 470 1) ((e,..- MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> XWell Installation ❑Well Destruction Blank Feet Screen Feet <br /> []Boring <br /> Size: <br /> Boring Installation ❑Boring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> El Gravity XTremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 941b <br /> gall s Bas gallons Bags <br /> Thickest Thinnest 1t Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3% 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 0 5 1t°, ��0 j S� bS 't fv" <br /> 15 30 6 30 60 6 0 <br /> 1 35 7 35 70 7 <br /> 200 40 8 40 80 8 74 c � 1 1 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 www.s*cehd.com <br />