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SA U DAQU I N Environmental Health Department <br /> —COUNTY— <br /> . - Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 31 141 Inspector:84en,/ciiw�T0.0- CONSTRUCTION q <br /> Facility Address: 13 O i �d ( oe(G-faw ./"���ro/o�i-�a v� ATv,Pvr+) <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#:)5 g•y - 3 . g" Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: W Driiifn <br /> Driller Onsite: / Screen Length From: To: <br /> Consultant: te-I e J v� �<0 2 v-- Filter Pack From: To: <br /> Geologist:_,456i e, / Gut-42 tiY2 z Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND CHRZrr-aox <br /> Holding Temperature: COWLE"PON co imoht <br /> Method: C* mnd Sumacs <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑ Yes El No �ft• <br /> ft. <br /> SPOILS — <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: ,sot- <br /> ad <br /> sacaon = <br /> Covered: ❑ Yes El No = r <br /> If yes, material: _ <br /> GROUTING or DESTRUCTION Total Depth: I� 10, 5 _ <br /> Depth to Water: VV0 c JeL4-P V- ft• ' — n <br /> Grout Material: ih e0.'f Ge-VYLOVt-'F MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: -7 / (0 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation)4Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water cem6—nt-47-16`4 Water Cement 94 lb <br /> allons Rall ons Bags <br /> Thickest Thinnest tr Bags Thickest Thinnest 4"Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.51 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 2 Bentonite per 94 lb 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 so s <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 VISed Tic- 1V1 ,(��+ 4� b9 �110/16/2017 20 4D B 40 80 8 /� •0 VV �"�'n� OHl <br /> 1' o f a'5p ha (-I <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />