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_ . SWAM IN <br /> Environmental Health Department COUNTY—Greatness grows here <br /> ,��1I11//yy Monitoring Well/Soil Boring Inspection Report <br /> Date: 3 2Vl"Ilnspector: �l _"V-tP�A_ CONSTRUCTION <br /> Facility Addres : 2 6f 2 t 1 F ,'-r 17-0 NW`(i F_CW r <br /> Well Address: Total Depth: <br /> WP# 3 2 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: S i w9— <br /> Driller Onsite: coal 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 L1 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: YtT height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLE 1ON 1FnoN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �tt. <br /> ft. <br /> it. <br /> SPOILS = <br /> 0 <br /> Contamination Noted: ❑ Yes El No — <br /> If yes,spoils storage Location: abn.d <br /> an = 8 <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> ��II Yr' ((�� 5 <br /> GROUTING or DESTRUCTION Tota Depth:c%Ir0(tg_�w <br /> Depth to Water: 25D m — n. <br /> Grout Material:_PI <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ,Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> ❑ Gravity *remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest >tBags Thickest Thinnest 1Bags BerltO /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 1 0�y,.I_ <br /> 10 25 4 20 50 5 Tortccl to�s—>2 2 , �2gck\kO0S v�a�' CallA <br /> 15 30 6 30 60 6 <br /> 17.5 1 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 209 464-0138 1 www.s*cehd.com <br />