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SAN OAQ U I N Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 7-'b-tR Inspector: NO"StG4-4CONSTRUCTION <br /> Facility Address: St35" 41/0)(a-ZA"u <br /> Well Address: Total Depth: <br /> WP#'�3 Q3-71Y 8 3'rN.5-/ Well#: 1, -2 Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 1 :5Z <br /> Driller Onsite: 14 AA_ Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Tu w'" Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes E]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 ABOVE-GROUND <br /> Holding Temperature: COWLE N comPt.EnoN <br /> o <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No —tt' <br /> tt. <br /> tt. <br /> SPOILS = <br /> Contamination Noted: ❑ Yes ❑No =` <br /> If yes, spoils storage Location: slatted <br /> soon = <br /> Covered: ❑ Yes ❑No _ _ g,,,W Pack <br /> If yes, material: x <br /> GROUTING or DESTRUCTION Total Depth: It y <br /> Depth to Water: IS % <br /> Grout Material: Nd,09 CeOy" <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> E�Well Installation ❑Well 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 E?bther: Fr`e"'C44 Type of Method: <br /> at ent 471 Water Cement 941b <br /> N ns t Bas allons Bags <br /> Thickest Thinnest 1t Bags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.821 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 L 30 6 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 1 40 8 40 80 8 <br /> J <br /> 11" 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.s'cehd.com <br />