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S A N A 0 A Q U I N <br /> 1 •t; �:� Environmental Health Department <br /> —COUNTY— <br /> Greatness; . -� a <br /> • �•Py4,rs,�2:t grows here. i <br /> Monitoring Well/Soil Boring Inspection Report <br /> ni <br /> Date: Inspector: SXJL im CONSTRUCTION <br /> Facility Address: ItLV (GiW*Oiok Dr. <br /> Well Address: y�s1V ].Depth: <br /> WP# �Well#: 3 4�ing Rig type: <br /> Soil Boring#:Drilling Company: h Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: rtzAais Filter Pack From: To: <br /> Geologist: 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 oasing <br /> If yes, location and distance: .� height •' <br /> _QVT <br /> SAMPLING Ai6y4-0pEAM0 rxa �sTi eox <br /> Holding Temperature: � s 1ON c*18im77oN <br /> Method: CYWna sort�,—�^— <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑Yes ❑Noft• <br /> SPOILS <br /> Contamination Noted: ❑Yes ❑No o <br /> ar — •-.If yes,spoils storage Location: .5+b M: s <br /> ti .8 <br /> 140 <br /> Covered: Ell Yes []NosacIonNo <br /> If yes,material: <br /> GROUTING-or-DEST CTION Total Depth:-- _•_ <br /> Depth to Water: ft tt• <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation )IWell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑B Slot Size:oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drtll Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity XTr ❑Other: Type of Method: <br /> Water ement471b Water CemeM941b <br /> gallons Bagsgallons Be <br /> 07.5 <br /> kest Thlnnest s 'thickest Thinnest gases BentonitelCement Mlx -3"/e Mix s%MIX1. <br /> 5 s 1 s 10 1 Bentoniteper47lb 1.41 2.47 <br /> 10 2 l0 10 a Bentonteper 94lb 2.82 4.7 <br /> 1S a 1 <br /> 10 20 4 20 40 4 <br /> IZ5 25 5 25 so 5 <br /> 15 80 6 30 60 - 6 <br /> 17.5 1 as 7 35 70 7 <br /> 20 1 40 8 40 60 8 ' <br /> 10/16/2017 <br /> 1868 E.Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 I F 209 464-0138 1 www•sfcehd.com <br />