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P1` ? SANdGAQUIN <br /> Environmental Health Department <br /> -'' —COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �! / 1 Ins p ctor CONSTRUCTION <br /> Facility Address: 1�� oz) <br /> Well Address: Total Q o'3Dgh:� �t Q <br /> WP# �� Well#: Drilling Rig Tye: <br /> Soil Boring#: C , f ( 2 Min 2"Annular EHD Seal Verified: El Yes ❑No <br /> Drilling Company: r 0"/-� C"P �,pt, <br /> Driller Onsite: An�44 Screen Length From: To: <br /> Consultant: [A/ o U -X,C Filter Pack From: To: <br /> Geologist: PiK 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: height <br /> —CWT <br /> SAMPLING Agpyg c,ROMO <br /> Holding Temperature: OOMPLErtON OOMPLEnoN <br /> Method: Ground Sumacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft• <br /> ft. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes 0 N r` <br /> If yes, spoils storage Location: watt" <br /> sacdon � — 3 <br /> Covered: 11Yes ElNo l = - 9-61 <br /> If yes, material: <br /> GROUTING or DESTRUCTIONrT tal Depth: �(xZ . <br /> Depth to Water: -t n- n• <br /> Grout Material: <br /> Gallons of Grout Used: / Q MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring InstallatioriliWoring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity %Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallons Baits <br /> Thickest Thinnest pBags Thickest Thinnest ttBags 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 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 2040 8 40 80 8 <br /> , Q _ ` ­; b,C 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />