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SAN.dOA UIN <br /> rr , Q Environmental Health Department <br /> I _ —COUNTY— <br /> Greatness grows here. <br /> / Monitoring Well/Soil Boring Inspection Report <br /> Date: `�� Z� Inspector: CONSTRUCTION <br /> Facility Address: �D Ni I <br /> Well Address: Total Depth: I5 " �� <br /> WP# Well#: � Drilling Rig Type: <br /> Soil Boring#: Min 2' Annular EHD Seal Verified: [I Yes ❑No <br /> ny:Drilling Compa <br /> Driller Onsite: <br /> Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: J s Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes FIN o$ COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes []No caging <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> COh1PLETION CO <br /> Holding Temperature: cOMPLEnon4PlETION <br /> Method: GaWnd Burl ne 7 <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑Non• <br /> _n. <br /> n. <br /> SPOILS <br /> 7 0 <br /> Contamination Noted: ❑ Yes ONO <br /> If yes,spoils storage Location: <br /> slotted <br /> sac0on c <br /> Covered: El Yes ONO c gravel Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> 2ol <br /> Depth to Water: �f n• — n• <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size:Boring Installation Destruction Bags of 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 Cement 471b Water Cement 941b <br /> allons Bags allons Bags <br /> Thickest hinnest eBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% MIX 5%MIX <br /> 2.s 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> s l0 2 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 is 3 15 30 3 I- <br /> 10 20 4 20 40 4 <br /> 115 25 5 25 so 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 30 B <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.smcehd.com <br />