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SQ N -J OAQ U I N Environmental Health Department <br /> ---COUNTY'--- <br /> °Rc,:,-,oN" Greotness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector:. 1 CONSTRUCTION J ��1 <br /> FacilityAddress: r 2'�Z t� °� .# (V�,04 V'�O <br /> Well Address: Total Depth: vjS iA- <br /> WP# 00 Well#: Drilling Rig Type: <br /> Soil Boring#: –� <br /> Drilling Company: Min 2"Annular EHD Seal Verified: 11 Yes []No <br /> Driller Onsite: 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 ❑No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: WT <br /> height <br /> SAMPLING ABOVEGROUND <br /> Holding Temperature: COMPLETION COOMPLEnoN <br /> Method: G=nd Suri"' '"+ <br /> Screening Method: arl«n <br /> Verified Chain of Custody: ❑ Yes El No <br /> n. <br /> ft. <br /> SPOILS - — <br /> Contamination Noted: ❑ Yes El No — <br /> If yes,spoils storage Location: slonad _ B <br /> aacdon <br /> Covered: ❑ Yes ❑No <br /> Z g-1 Pack <br /> If yes, material: <br /> GROUTING or DEST4UCTICIN Total Depth: _ <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation 1113oring 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 lYremie ❑Other: Type of Method: <br /> Water a ent 471b Water Cement 94 lb <br /> V.allo Bas gall ons Bags <br /> Thickest Thinnest it Bags Thickest Thinnest J1 Bags Bentonite/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 <br /> 10 20 4 20 t70 <br /> 4 <br /> 12.5 25 5 25 5 <br /> 15 30 6 30 6 <br /> 17.5 35 7 35 7 <br /> 20 40 8 40 8 <br /> To I, 11 ( 'O . / rh, /1 � 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 I www.sucehd.com <br />