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ti � le <br /> $ANJOAQUIw Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: S(AkAWjt CONSTRUCTION <br /> Facility Address: 666 L P"i _L <br /> Well Address: Total Depth: <br /> WP# nn/-1o62!. Well#: Drilling Rig Type: <br /> Soil Boring#: S4 wo WS Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: L 6(_122 1Q <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: �w Filter Pack From: To: <br /> Geologist: g/7iTmi Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No <br /> Y COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ONO casing <br /> If yes, location and distance: IMT height <br /> SAMPLING ABOVE•CACUND ctua M-Box <br /> Holding Temperature: COWLIE-TION COMPLETION <br /> Method: orwro suriacv <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes ❑No �tt' <br /> tt. <br /> SPOILS <br /> ji <br /> Contamination Noted: ❑ Yes ❑No — <br /> -_ <br /> If yes, spoils storage Location: abttad 8 <br /> a�rion ia' = <br /> Covered: ❑Yes ❑No = gra-1tack <br /> If yes, material: ?M W S^ h <br /> 7 SIG <br /> GROUTING or DESTRUCTION Total Depth: MWG-a zo' <br /> Depth to Water: �127 <br /> Grout Material: N2Af" i1tat9ftic MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> []Well Installation YSWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring 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 ment 471b Water Cement 941b <br /> allons Ba s allons Bags <br /> F2. <br /> Thinnest #Bags Thickest Thinnest bBags BentonitefCement Mix 3% MIX 5%MIX <br /> 5 1 5 10 1 Bentonlle er 47 Ib 1.41 2.47 <br /> 10 2 10 202Bentonlle er 941b 2.82 4.7 <br /> 15 3 15 30 3 20 4 20 40 4 25 5 25 50 530 6 30 60 6 RW61 — to 35 7 35 70 7 1Y1W 41 �' q40 8 40 80 8 /► _ A�W 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s4cehd.com <br />